Dry AMD with subretinal fluid is an important clinical entity to recognize to avoid unnecessary anti-vascular endothelial growth factor therapy, a new study in the British Journal of Ophthalmology reports.

The international team of researchers also suggest clinicians should be aware that subretinal fluid can be associated with drusen or drusenoid pigment epithelial detachment (PED) in the absence of macular neovascularization and may be the result of retinal pigment epithelial decompensation and retinal pigment epithelial pump failure.

The retrospective investigation included 45 eyes of 45 patients with dry AMD and associated subretinal fluid who were followed for approximately 50 months. The researches collected spectral-domain OCT (SD-OCT) images at baseline and again at follow-up, and also performed a qualitative and quantitative image analysis of macular drusen, including drusenoid PED, and associated subretinal fluid to determine anatomic outcomes.

The researchers found the subretinal fluid exhibited three different morphologies:

  • Crest of fluid over the apex of the drusenoid PED.
  • Pocket of fluid at the angle of a large druse or in the crypt of confluent drusen.
  • Drape of low-lying fluid over confluent drusen.

Of note: 60% of eyes displayed collapse of the associated druse or drusenoid PED and 24 53% showed evidence of complete or incomplete retinal pigment epithelial and outer retinal atrophy.

Hilely A, Au A, Freund KB, et al. Non-neovascular age-related macular degeneration with subretinal fluid. British Journal of Ophthalmology. September 12, 2020. [Epub ahead of print].