Longitudinal Assessment of Age-Related Macular Degeneration Using Ultrawidefield Imaging: The Optos Peripheral Retina Follow-up Study

Purpose: With the widespread availability of Ultrawidefield (UWF) imaging, peripheral retinal abnormalities in age-related macular degeneration (AMD) have garnered attention. However, longitudinal studies of AMD peripheral findings are limited. This study aimed to characterize and quantify these features over 5 years.

Design: Longitudinal ancillary study.

Participants: The Optos Peripheral Retina (OPERA) study was an ancillary study of the Age-Related Eye Disease Study 2. A total of 137 participants (265 eyes) in the OPERA study with gradable UWF color and autofluorescence imaging at years 5 and 10 were included.

Methods: Ultrawidefield color and autofluorescence images were captured using Optos UWF devices and were graded at the Wisconsin Reading Center for macular and peripheral AMD features using the 3-zone OPERA study grid.

Main outcome measures: Presence of peripheral retinal lesions (neovascular AMD, geographic atrophy [GA], drusen, increased pigment, decreased pigment, reticular pseudodrusen, reticular pigmentary changes, and cobblestone degeneration) and their association with central AMD progression.

Results: In zone 1 at year 5 and year 10, the AMD severity scale (AMDSS) score was ≤ 5 in 8% and 6%, 6 to 8 in 49% and 30%, noncentral and central GA in 15% and 27%, and neovascular AMD in 28% and 37%, respectively. In zone 2, peripheral AMD abnormalities in year 5 versus year 10 included: drusen, 99% versus 99%; hyperpigmentation, 11% versus 11%; and hypopigmentation, 4% versus 7%, respectively. Peripheral degenerations not associated with AMD were present in year 5 versus year 10 as follows: cobblestone, 19% versus 30%; and reticular pigmentary changes, 25% versus 33%, respectively. Among eyes with an AMDSS level of 6 to 8 at year 5, progression to late AMD occurred in 41% without substantial peripheral findings and in 41% with such findings, which include drusen of ≥ 1 disc area, any hypopigmentation or hyperpigmentation in zones 2 or 3, or a combination thereof.

Conclusions: The OPERA study revealed that AMD features often extend beyond the macula, suggesting that AMD is a panretinal disease. In this study, peripheral findings were not associated with increased risk of progression to late AMD.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.