Ophthalmology (Eye & Ear Hospital) - Research Publications

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Author: Fletcher, Erica × Author: Guymer, Robyn × Author: Wu, Zhichao ×

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    Genetics of reticular pseudodrusen in age-related macular degeneration
    Farashi, S ; Ansell, BRE ; Wu, Z ; Abbott, CJ ; Pebay, A ; Fletcher, EL ; Guymer, RH ; Bahlo, M (CELL PRESS, 2022-04)
    Reticular pseudodrusen (RPD) are subretinal deposits and when observed with age-related macular degeneration (AMD) form a distinct phenotype, often associated with late-stage disease. To date, RPD genetic risk-associations overlap six well-established AMD-risk regions. Determining RPD-specific underlying genetic causes by utilising adequate imaging methods should improve our understanding of the pathophysiology of RPD.
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    Reticular pseudodrusen: A critical phenotype in age-related macular degeneration
    Wu, Z ; Fletcher, EL ; Kumar, H ; Greferath, U ; Guymer, RH (PERGAMON-ELSEVIER SCIENCE LTD, 2022-05)
    Reticular pseudodrusen (RPD), or subretinal drusenoid deposits (SDD), refer to distinct lesions that occur in the subretinal space. Over the past three decades, their presence in association with age-related macular degeneration (AMD) has become increasingly recognized, especially as RPD have become more easily distinguished with newer clinical imaging modalities. There is also an increasing appreciation that RPD appear to be a critical AMD phenotype, where understanding their pathogenesis will provide further insights into the processes driving vision loss in AMD. However, key barriers to understanding the current evidence related to the independent impact of RPD include the heterogeneity in defining their presence, and failure to account for the confounding impact of the concurrent presence and severity of AMD pathology. This review thus critically discusses the current evidence on the prevalence and clinical significance of RPD and proposes a clinical imaging definition of RPD that will help move the field forward in gathering further key knowledge about this critical phenotype. It also proposes a putative mechanism for RPD formation and how they may drive progression to vision loss in AMD, through examining current evidence and presenting novel findings from preclinical and clinical studies.
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    Subthreshold Nano-Second Laser Treatment and Age-Related Macular Degeneration
    Cohn, AC ; Wu, Z ; Jobling, AI ; Fletcher, EL ; Guymer, RH (MDPI, 2021-02)
    The presence of drusen is an important hallmark of age-related macular degeneration (AMD). Laser-induced regression of drusen, first observed over four decades ago, has led to much interest in the potential role of lasers in slowing the progression of the disease. In this article, we summarise the key insights from pre-clinical studies into the possible mechanisms of action of various laser interventions that result in beneficial changes in the retinal pigment epithelium/Bruch's membrane/choriocapillaris interface. Key learnings from clinical trials of laser treatment in AMD are also summarised, concentrating on the evolution of laser technology towards short pulse, non-thermal delivery such as the nanosecond laser. The evolution in our understanding of AMD, through advances in multimodal imaging and functional testing, as well as ongoing investigation of key pathological mechanisms, have all helped to set the scene for further well-conducted randomised trials to further explore potential utility of the nanosecond and other subthreshold short pulse lasers in AMD.