Prevalence and risk factors of peripheral retinal changes in the elderly using ultra-wide field imaging: the alienor study
Résumé
Purpose: To determine the prevalence and associated risk factors of peripheral retinal lesions resembling age-related macular degeneration (AMD) using ultra-wide field (UWF) imaging. Methods: 376 subjects, aged 75 years or more, underwent UWF imaging by Optomap P200C (Optos plc, United Kingdom) between 2009 and 2011. Presence of peripheral soft drusen, hard drusen, retinal pigment epithelial (RPE) changes, atrophy or choroidal neovascularisation (CNV) was graded at the Moorfields Eye Hospital Reading Center using a standardized grading protocol. Associations of these peripheral lesions with AMD (graded according to the international classification from non mydriatic colour retinal photographs) and AMD risk factors were estimated using Generalized Estimating Equation logistic regressions. Results: 61% of the participants had peripheral retinal lesions resembling AMD, 51% had peripheral soft drusen, 31.3% peripheral hard drusen, 12.2% peripheral RPE changes and 4.5% peripheral atrophy. There was no peripheral lesion like PED (pigment epithelial detachment) or CNV. After adjustment for age and gender, peripheral soft drusen were associated with atrophic AMD (OR=4.66, p=0.0085) while peripheral RPE changes were associated with neovascular AMD (OR =4.12, p=0.014). Peripheral soft drusen were positively associated with complement factor H (CFH) Y402 H polymorphism (OR=1.85, p=0.008 for TC genotype and OR=2.47, p=0.01 for CC) and negatively associated with high BMI (OR= 0.47, p=0.02). Conclusions: Phenotyping peripheral changes with UWF imaging confirms the presence of widespread age-related changes outside the macular area, which are more frequent in subjects with AMD, as well as in subjects with genetic susceptibility to AMD, conferred by the CFH Y402 polymorphism.
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