Original article
The Epidemiology of Retinal Reticular Drusen

https://doi.org/10.1016/j.ajo.2007.09.008Get rights and content

Purpose

To describe the prevalence and 15-year cumulative incidence of and risk factors for reticular drusen.

Design

Population-based prospective study.

Methods

Four thousand nine hundred and twenty-six persons, 43 to 86 years of age, were included between 1988 and 1990, of whom 3,684, 2,764, and 2,119 participated in five-, 10-, and 15-year follow-up examinations, respectively, in Beaver Dam, Wisconsin. Main outcome measures included prevalence and 15-year incidence of reticular drusen determined by grading stereoscopic color fundus photographs.

Results

The prevalence at baseline and the 15-year cumulative incidence in either eye of reticular drusen was 0.7% and 3.0%, respectively. The 15-year incidence of reticular drusen varied with age from 0.4% in those 43 to 54 years of age to 6.6% in those 75 years or older at baseline (P < .001). In a multivariate model, while controlling for age, risk factors statistically significantly associated with increased risk of incident reticular drusen included: being female (odds ratio [OR], 2.8), current smoking (OR vs never, 1.9), less education (OR per category, 1.7), B-vitamin complex use (OR vs none, 2.5), single vitamin B (OR vs none, 2.9), history of steroid eye drops use (OR, 5.9), glaucoma (OR, 2.8), and more severe drusen type (e.g., soft indistinct drusen; OR, 1.4), whereas diabetes (OR, 0.1) at baseline was associated with decreased risk. Right eyes with reticular drusen at baseline had higher cumulative incidence of geographic atrophy (21% vs 9%) and exudative age-related macular degeneration [AMD] (20% vs 10%) compared with eyes with soft indistinct drusen.

Conclusions

This population-based study documents the long-term cumulative incidence of reticular drusen and its risk factors and shows its association with a high risk of incident late AMD.

Section snippets

Population

Methods used to identify the population and descriptions of the population have appeared in previous reports.9, 10, 11, 12, 13 A private census of the population of Beaver Dam, Wisconsin (99% White), was performed from fall 1987 through spring 1988.9 Of the 5,924 enumerated persons aged 43 to 84 years, 4,926 (83.2%) participated in the baseline examination from 1988 through 1990.10 Of these, 3,684 (81.1%) participated in the five-year follow-up examination from 1993 through 1995.11 Comparisons

Prevalence

Reticular drusen were present in 0.7% of the cohort at baseline, and the frequency was similar in the right (0.7%) and left (0.5%) eyes. Of the 32 people at baseline with reticular drusen, 20 (63%) had it in both eyes. When present, they were found outside the macula defined by the grid 81% of the time (Figure 2, Left). When present in the macular area, they were found most commonly in the outer superior subfield 74% of the time, in the outer temporal subfield 70% of the time, and never in the

Discussion

Using standardized detailed procedures for obtaining stereoscopic color fundus photographs of the macula and an objective system for grading those photographs for AMD, we found a prevalence of reticular drusen of 0.7% and a 15-year cumulative incidence, accounting for the competing risk of death, of 3.0% in the Beaver Dam population aged 43 to 86 years of age at baseline. In addition, we report a high 15-year cumulative incidence of late AMD (43% and 46% in right and left eyes, respectively)

Dr Ronald Klein is a Professor of Ophthalmology and Visual Sciences at the University of Wisconsin School of Medicine and Public Health and is interested in ocular epidemiology of age-related eye disease and hypertensive and diabetic retinopathy.

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