Impact of bleaching on photoreceptors in different intermediate AMD phenotypes

Purpose: To investigate photoreceptors’ structural changes after photobleaching exposure in intermediate age-related macular degeneration (iAMD) eyes with and without reticular pseudodrusen (RPD). Methods: In this prospective, cross-sectional study, were enrolled iAMD patients and healthy controls. Patients and controls underwent repeated imaging with spectral-domain optical coherence tomography (SD-OCT), at baseline and at three intervals after bleaching, during the subsequent recovery in darkness. Structural changes in photoreceptors were investigated in the foveal region and in four perifoveal areas. Results: Twenty eyes of 20 iAMD patients (12 with RPD and 8 without RPD) and 15 age-matched healthy controls were enrolled. At baseline, the photoreceptor outer segment (OS) volume was significantly reduced in iAMD eyes with RPD compared with controls, in the foveal and perifoveal regions. In healthy subjects, a precocious increase in OS volume was observed after bleaching in the foveal region, and a rapid recovery to baseline values was recorded. In the perifoveal regions, an increase in OS volume was observed 10 minutes after light onset. In contrast, in iAMD subjects with RPD an altered response to photobleaching, in the foveal and superior and inferior perifoveal regions, was recorded. Conclusions: Our imaging evidences support the hypothesis that dark adaptation is more altered in eyes with RPD. The structural modifications may explain the functional increased damage of the retinal pigment epithelium and photoreceptors reported in eyes with RPD. Translational Relevance: OCT imaging may be used to assess dark adaptation in AMD eyes.