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Objective: To show morphologic and angiographic changes in the peripheral retina in patients with agerelated macular degeneration (AMD) using wide-field fundus imaging, and to compare these findings with those from healthy controls. Design: Cross-sectional clinical study. Participants: In total, 152 patients with clinical AMD and 150 healthy controls (without AMD in either macula) were studied. Subjects were 50 years of age. Exclusion criteria were diabetic retinopathy, previous retinal surgery, high myopia, or dense cataract, as well as any retinal inflammatory, degenerative, or occlusive disease. Methods: For both groups of patients, color fundus images were captured with the Optos P200 MA camera (Optos, Dunfermline, Scotland). Image analysis software was used to characterize each image. Angiography was performed on the AMD group only. Morphological and angiographic peripheral retinal changes were studied per the frequency of their occurrence, the affected peripheral retina (clock hours), and the localization of peripheral changes with regard to the eye equator. Statistical significance was defined at a level of P < 0.05. Main Outcome Measures: Peripheral changes in both groups according to their type and frequency (percentage of eyes with detected retinal changes), the number of clock hours of affected peripheral retina, and their localization with regard to the equator of the eye. Results: Drusen, reticular pigmentary changes, and paving stone degeneration occurred more frequently in the AMD group than in controls (P < 0.001, P < 0.001, and P < 0.001 respectively), whereas white without pressure occurred more frequently in the control group (P ¼ 0.027). In both groups, peripheral retinal changes were observed peripheral to the equator in more than 40% of analyzed eyes. In control Croatian subjects, peripheral drusen were seen in 38% of subjects compared with 68% of AMD subjects. Conclusion: Drusen, reticular pigmentary change , and paving stone degeneration occur significantly more frequently in subjects with AMD compared with controls. White without pressure degeneration was present in a high percentage of control subjects.

Importance Age-related cataract is a leading cause of visual impairment in the United States. The prevalence of age-related cataract is increasing, with an estimated 30.1 million Americans likely to be affected by 2020. Objective To determine whether daily oral supplementation with lutein/zeaxanthin affects the risk for cataract surgery. Design, Setting, and Patients The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, double-masked clinical trial, enrolled 4203 participants, aged 50 to 85 years, at risk for progression to advanced age-related macular degeneration. Interventions Participants were randomly assigned to daily placebo; lutein/zeaxanthin, 10mg/2mg; omega-3 long-chain polyunsaturated fatty acids, 1 g; or a combination to evaluate the effects on the primary outcome of progression to advanced age-related macular degeneration. Main Outcomes and Measures Cataract surgery was documented at annual study examination with the presence of pseudophakia or aphakia, or reported during telephone calls at 6-month intervals between study visits. Annual best-corrected visual acuity testing was performed. A secondary outcome of AREDS2 was to evaluate the effects of lutein/zeaxanthin on the subsequent need for cataract surgery. Results A total of 3159 AREDS2 participants were phakic in at least 1 eye and 1389 of 6027 study eyes underwent cataract surgery during the study, with median follow-up of 4.7 years. The 5-year probability of progression to cataract surgery in the no lutein/zeaxanthin group was 24%. For lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratios for progression to cataract surgery was 0.96 (95% CI, 0.84-1.10; P = .54). For participants in the lowest quintile of dietary intake of lutein/zeaxanthin, the hazard ratio comparing lutein/zeaxanthin vs no lutein/zeaxanthin for progression to cataract surgery was 0.68 (95% CI, 0.48-0.96; P = .03). The hazard ratio for 3 or more lines of vision loss was 1.03 (95% CI, 0.93-1.13; P = .61 for lutein/zeaxanthin vs no lutein/zeaxanthin). Conclusions and Relevance Daily supplementation with lutein/zeaxanthin had no statistically significant overall effect on rates of cataract surgery or vision loss. Trial Registration clinicaltrials.gov Identifier:NCT00345176.

Using computerized analysis, drusen size, distribution, and total drusen area were determined in two central macular regions of subjects enrolled in two clinical dry AMD trials. Drusen area measured as a continuous variable was not a significant risk factor for conversion in most statistical models.

Medical imaging has long played a critical role in diagnosing and assessing various pathologic conditions. In the past decade alone, along with the rapid evolution of computer technologies, various new imaging modalities have been introduced. These provide three-dimensional (3D) image datasets and are proving themselves to be clinically useful. One of the main advantages afforded with a 3D image dataset is flexible image visualization capability. One can slice the target tissue in any arbitrary plane, allowing clinicians to study abnormalities from various vantage points (e.g., sagittal, coronal, and horizontal sections). Optical coherence tomography (OCT) was developed in 1991 and was commercially introduced to ophthalmology in 1996.1,2 First-generation OCT instruments provided a 2D cross-sectional view of the human retina at a microscopic resolution (10 μm) in vivo. Because of its noncontact and noninvasive imaging capabilities, OCT quickly became an indispensable clinical tool for assessing retinal abnormalities, including the leading causes of blindness: age-related macular degeneration, diabetic retinopathy, and glaucoma.2–5 New techniques based on spectral/Fourier domain detection have achieved approximately 50× increases in imaging speeds.6–8 With its fast axial imaging rate, SD-OCT has enabled us to obtain relatively high-density 3D cube data of the human retina within a reasonable scan time (e.g., 27 kHz sampling or 200 × 200 × 1024 samples in approximately 1.48 seconds; Fig. 1a). Although conventional C-mode images along the planes perpendicular to the scanning axis provide an interesting perspective, interpretation of such C-mode images is not intuitive because multiple different retinal layers are sliced in the same view given the natural spherical curvature of the eye (Fig. 1b).9,10 In addition to this natural tissue curvature, an eye moves along the z-axis on a microscopic scale even within the short scanning time, leading to a distorted 3D SOCT image dataset (Fig. 1c). Figure 1 (a) SD-OCT sample images showing (left) horizontal slice and (right) circular slice. (b) Conventional C-mode view of human retina obtained by prototype SD-OCT unit (501 × 180 × 1024 samplings in a 6 × 6 × 1.4-mm region). ... A commercial SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, CA; software version 3.0) was used to solve this problem because it provides the capability of sampling the OCT data set along a segmented layer (internal limiting membrane [ILM], retinal pigment epithelium [RPE], or fitted curve to the RPE) with arbitrary thickness. This segmented C-mode method contains only structures in the segmented layer(s) and provides an improved view compared with conventional C-mode, which intersects multiple tissue planes (Fig. 2). Unfortunately, the quality of the segmented C-mode image depends on the quality of the automated segmentation algorithm performance. The deterioration of segmentation algorithm performance in the presence of retinal pathology is well described (Fig. 3).11,12 Figure 2 OCT segmented C-mode image. C-mode image (left) shows a projection from the ILM (right, within light blue lines) with a thickness of 23 μm. Figure 3 Segmentation error sample. The segmented ILM border (top, light blue line) is not following the ILM properly at the cystic lesion (arrows) because of unusual retinal structure and poor signal quality. The smoothed fitted line (magenta) of the RPE also ... The purpose of this study was to develop a method to easily isolate structures of interest (SoIs) while generating C-mode images in a semiautomated fashion and to describe the clinical applications of such a technique.