1, 2 and 21 Different clinical subtypes of drusen have been described in AMD, but all drusen seem to be indistinguishable in location, composition, and substructure.5 “Basal laminar drusen,” also termed “cuticular drusen,” refers to an early-onset drusen phenotype with innumerable small (25

to 75 μm) hard drusen.22 and 23 This subtype of AMD is more easily visualized angiographically than biomicroscopically, with a typical “stars-in-the-sky” PD98059 appearance during the early arteriovenous phase of fluorescein angiography (Figure 1).24 In later stages, the number of drusen often increases, with clustered groups of drusen scattered throughout the retina.22 In general, color fundus photographs are used to evaluate the morphology of drusen over time. However, color images do not provide detailed information about the changing morphology

of small drusen.25, 26 and 27 PR-171 mw The introduction of spectral-domain optical coherence tomography (SD-OCT) has enabled an improved in vivo visualization of drusen morphology.28 SD-OCT is able to acquire 3-dimensional images of the retina with high speed and high resolution. Subsequently, studies of the fine details of small drusen and adjacent retinal structures become possible.28 and 29 After we observed occasional changes of drusen morphology in routinely followed eyes with basal laminar drusen, we decided to longitudinally investigate the appearance Adenosine of small hard drusen in eyes with this phenotype. The focus of our investigation was to determine whether morphologic parameters may be predictive for processes of progression or regression of small hard drusen in basal laminar drusen affected eyes. A total of 10 subjects who met the diagnostic criteria of basal laminar drusen were retrieved from the European Genetic Database (EUGENDA, www.eugenda.org), a large multicenter database for clinical and molecular analysis of AMD and different early-onset drusen phenotypes.

For inclusion in the study, subjects had basal laminar drusen of the posterior pole and ocular media allowing adequate SD-OCT scanning, defined by a maximum score of NO3/NC2/C1/P1 according the Lens Opacities Classification System III.30 Study participants had to be able to fixate for at least 1 minute per eye to allow adequate SD-OCT scanning. The basal laminar drusen phenotype was defined as a symmetrically distributed pattern between both eyes of at least 50 scattered, uniformly sized, small (25 μm to 75 μm), hyperfluorescent drusen on fluorescein angiography in each eye, of which at least 20 drusen are located outside the Wisconsin age-related maculopathy grading template.31 Eyes with choroidal neovascularization (CNV), a large area of central geographic atrophy (>1500 μm), and retinal abnormalities other than AMD-related were excluded from the study.