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Purpose <p>To evaluate choroidal vasculature in intermediate age-related macular degeneration (AMD) based on drusen phenotypes and to understand the relationship between drusenoid pigment epithelial detachment (PED) distribution and the choroidal vascularity index (CVI).</p> Methods <p>In this retrospective cross-sectional study, patients with intermediate AMD were included. Eyes were divided into three groups based on drusen phenotype: PED, PED combined with reticular pseudodrusen (RPD), and RPD alone. Plex Elite 9000 device (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography was used to obtain sector-wise measurements of choroidal thickness (CT), choroidal volume (CV), and choroidal vascularity index (CVI) using the Zeiss Advanced Research and Innovation Network (<a href="http://www.arinetworkhub.com">www.arinetworkhub.com</a>). Drusenoid PED area and volume were quantified using automated RPE elevation analysis. CVI heat maps were converted to pixel-wise quantitative values and spatially co-registered with drusen maps. Mean CVI was compared between drusen and non-drusen regions. To assess the spatial relationship between drusen distribution and choroidal vascularity, an enrichment ratio (ER) analysis was performed, defined as the proportion of drusen pixels located in high-CVI regions divided by the baseline proportion of high-CVI pixels, using percentile-based CVI thresholds.</p> Results <p>A total of 47 eyes from 34 patients (21 females) were included. Eyes with RPD alone (5 eyes) exhibited significantly reduced CT across all macular regions compared with PED-only (26 eyes) and PED + RPD eyes (16 eyes) (overall <i>p</i> = 0.005), along with significantly lower central and parafoveal choroidal volume. Mean CVI did not differ significantly among the three groups; however, CVI was positively correlated with both choroidal thickness and choroidal volume (<i>r</i> = 0.37, <i>p</i> ≤ 0.01). Mean CVI was significantly higher in drusen areas compared to non-drusen regions (0.61 ± 0.09 versus 0.5 ± 0.07, <i>p</i> &lt; 0.001). (<i>p</i> &lt; 0.001), with ERs indicating preferential localization of drusen within high-CVI regions. The mean ER at the 75th CVI percentile was 1.74 ± 0.36, suggesting that drusenoid PEDs were 74% more likely to occur in regions with high CVI (top 25%).</p> Conclusion <p>In intermediate AMD, RPDs are associated with marked choroidal thinning and volume reduction, highlighting the primary choroidal involvement in this phenotype. The preferential localization of drusenoid PEDs in regions with higher CVI emphasizes complex, localized choroidal–RPE interactions in AMD pathogenesis.</p>

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High choroidal vascularity index zones favor the distribution of drusenoid pigment epithelial detachment in intermediate age-related macular degeneration

  • 期刊论文

  • 发表日期：

    2026年4月23日

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  • Giulia Gregori,
  • Niroj Kumar Sahoo,
  • Shreyaa Rohindra Lall,
  • Elham Sadeghi,
  • Anne Schulman,
  • Nasiq Hasan,
  • Jay Chhablani

摘要

Purpose

To evaluate choroidal vasculature in intermediate age-related macular degeneration (AMD) based on drusen phenotypes and to understand the relationship between drusenoid pigment epithelial detachment (PED) distribution and the choroidal vascularity index (CVI).

Methods

In this retrospective cross-sectional study, patients with intermediate AMD were included. Eyes were divided into three groups based on drusen phenotype: PED, PED combined with reticular pseudodrusen (RPD), and RPD alone. Plex Elite 9000 device (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography was used to obtain sector-wise measurements of choroidal thickness (CT), choroidal volume (CV), and choroidal vascularity index (CVI) using the Zeiss Advanced Research and Innovation Network (www.arinetworkhub.com). Drusenoid PED area and volume were quantified using automated RPE elevation analysis. CVI heat maps were converted to pixel-wise quantitative values and spatially co-registered with drusen maps. Mean CVI was compared between drusen and non-drusen regions. To assess the spatial relationship between drusen distribution and choroidal vascularity, an enrichment ratio (ER) analysis was performed, defined as the proportion of drusen pixels located in high-CVI regions divided by the baseline proportion of high-CVI pixels, using percentile-based CVI thresholds.

Results

A total of 47 eyes from 34 patients (21 females) were included. Eyes with RPD alone (5 eyes) exhibited significantly reduced CT across all macular regions compared with PED-only (26 eyes) and PED + RPD eyes (16 eyes) (overall p = 0.005), along with significantly lower central and parafoveal choroidal volume. Mean CVI did not differ significantly among the three groups; however, CVI was positively correlated with both choroidal thickness and choroidal volume (r = 0.37, p ≤ 0.01). Mean CVI was significantly higher in drusen areas compared to non-drusen regions (0.61 ± 0.09 versus 0.5 ± 0.07, p < 0.001). (p < 0.001), with ERs indicating preferential localization of drusen within high-CVI regions. The mean ER at the 75th CVI percentile was 1.74 ± 0.36, suggesting that drusenoid PEDs were 74% more likely to occur in regions with high CVI (top 25%).

Conclusion

In intermediate AMD, RPDs are associated with marked choroidal thinning and volume reduction, highlighting the primary choroidal involvement in this phenotype. The preferential localization of drusenoid PEDs in regions with higher CVI emphasizes complex, localized choroidal–RPE interactions in AMD pathogenesis.