Macular Degeneration: Pulido JS

Donaldson MJ, Pulido JS. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. · Curr Opin Ophthalmol. · Pubmed #16794439 No free full text.

Abstract: PURPOSE OF REVIEW: The purpose of this report is to review the recent literature and summarize currently available and potential new treatment options for nonexudative age-related macular degeneration. RECENT FINDINGS: High-dose vitamin supplementation may have some associated systemic toxicity. It is important to check that the patient is taking beta-carotene and not vitamin A as retinal acetate or palmitate, which have been associated with osteoporosis and hepatotoxicity. High-dose vitamins E and C may be associated with cardiovascular disease. Decreasing inflammation by lowering systemic cardiac C-reactive protein, fibrinogen and cholesterol may be important, especially in light of recent epidemiologic and genetic data. The results of randomized trials of laser treatment for drusen and rheopheresis should be available during 2006. Treatment with these modalities before the results of the trials are evaluated should be avoided. SUMMARY: The holy grail of therapy for age-related macular degeneration is to avoid the development of choroidal neovascularization. High-dose vitamin supplementation should be used only in those in whom it is indicated and inflammatory parameters including highly sensitive C-reactive protein, fibrinogen and cholesterol should be stabilized because there are data associating these parameters with age-related macular degeneration and also with cardiovascular disease.

Pulido JS, Sanders D, Klingel R. · Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, and Department of Ophthalmology, University of Illinois, College of Medicine, Chicago, USA. · Can J Ophthalmol. · Pubmed #15947803 links to  free full text

Abstract: BACKGROUND: Rheopheresis is being evaluated in a clinical trial. The rationale and available results are presented. METHODS: We reviewed the literature about the pathophysiology of age-related macular degeneration (AMD) that might support the use of rheopheresis. In addition, we reviewed the previously published results of the use of rheopheresis for AMD. RESULTS: There appears to be a diffusion barrier caused by accumulation of cross-linked proteins known as advanced macular oxidation products (AMOPS) in AMD. Rheopheresis allows removal of uncross-linked proteins and facilitates antioxidant entry into Bruch's membrane, preventing further accumulation of AMOPS. The Multicenter Investigation of Rheopheresis for AMD (MIRA-1), an ongoing double-masked randomized trial, should determine the efficacy of rheopheresis in preventing the progression of AMD. The interim results, from an analysis of visual acuity data for 43 patients, are encouraging, confirming the potential of rheopheresis as a therapeutic option for dry AMD. The benefit was evident immediately after treatment and remained essentially stable throughout the 12-month period of evaluation. Eyes with late-stage, high-risk, dry AMD appeared to be at significant risk for substantial vision loss over the 12 months if not treated. Subgroup analysis demonstrated that the timing of rheopheresis in the course of a patient's disease may have a pronounced effect on outcome. INTERPRETATION: There appears to be a rationale for the use of rheopheresis in AMD. Further results of the clinical trial are awaited.

Pulido JS, Anonymous00290. · Department of Ophthalmology and Visual Sciences, UIC Eye Center, University of Illinois at Chicago, USA. · Trans Am Ophthalmol Soc. · Pubmed #12545682 links to  free full text

Abstract: OBJECTIVE: To evaluate the safety and efficacy of Rheopheresis blood filtration to treat intermediate- to late-stage preangiogenic age-related macular degeneration (AMD) with soft drusen. DESIGN: Multicenter, prospective, randomized, double-masked, placebo-controlled clinical trial. PARTICIPANTS: First 43 randomized patients (28 Rheopheresis and 15 placebo-control patients) with available baseline and 3-month postbaseline best corrected visual acuity (BCVA) measurements and intermediate- to late-stage preangiogenic AMD with multiple large soft drusen and elevated serum levels of targeted macromolecules. INTERVENTION: Patients were randomly assigned to receive eight Rheopheresis or eight placebo procedures over 10 weeks. MAIN OUTCOME MEASURES: ETDRS BCVA measurements at baseline, 3, 6, 9, and 12 months postbaseline. RESULTS: In primary eyes, the mean LogMAR line difference between Rheopheresis and placebo-control eyes was 1.6 lines at 12 months postbaseline; the difference was significant throughout the first posttreatment year (P = .0011, repeated measures analysis). Thirteen percent of Rheopheresis compared with 0% of placebo-control eyes had a > or = 3-line improvement in BCVA at 12 months postbaseline. Four percent of Rheopheresis compared with 18% of placebo-control eyes had a > or = 3-line loss in BCVA. The subgroup of patients whose primary eyes had baseline BCVA worse than 20/40 demonstrated a mean LogMAR difference between Rheopheresis and placebo-control eyes equaling 3.0 lines at 12 months postbaseline; the difference was significant throughout the first posttreatment year (P = .0014, repeated measures analysis). Sixteen percent of Rheopheresis compared with 0% of the placebo-control eyes had a > or = 3-line improvement in BCVA at 12 months postbaseline. Five percent of Rheopheresis compared with 29% of placebo-control eyes had a > or = 3-line loss in BCVA. Fifty-eight percent of Rheopheresis eyes improved to 20/40 or better, compared with 14% of placebo-control eyes. No serious treatment-related adverse events were observed. CONCLUSIONS: Rheopheresis demonstrated statistically significant and clinically relevant effects on BCVA when compared with placebo controls for the 12-month study interval. Untreated patients with BCVA worse than 20/40 with intermediate- to late-stage preangiogenic AMD, soft drusen, and elevated blood factors were at risk for substantial visual loss. A sample size larger than 43 patients is important to provide a basis for widespread adoption of novel therapeutic options for AMD such as Rheopheresis. Therefore, enrollment to 150 patients is continuing.

Bakri SJ, Risco M, Edwards AO, Pulido JS. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA. · Am J Ophthalmol. · Pubmed #19403114 No free full text.

Abstract: PURPOSE: To report the outcomes and complications of bilateral simultaneous intravitreal injections performed in the office. DESIGN: Retrospective case series. METHODS: Records of 35 patients receiving simultaneous bilateral intravitreal injections between November 2007 and November 2008 were reviewed. Data collected included indication for injection, preinjection and postinjection intraocular pressure (IOP), preinjection and postinjection visual acuity (VA), and complications/complaints after each injection. RESULTS: A total of 208 injections were administered to 35 patients, with a mean of 5.9 injections per patient (range, 2 to 14; standard deviation [SD], 3.68). One hundred and thirty-three eyes received bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) alone, 14 received bevacizumab plus preservative-free intravitreal triamcinolone or Triescence (Kenalog; Bristol-Myers Squibb Co, New York, New York, USA), 56 received ranibizumab (Lucentis; Genentech Inc), and 5 received bevacizumab plus dexamethasone (Decadron; Merck, Whitehouse Station, New Jersey, USA). Mean time of postinjection follow-up was 39 days. Postinjection VA follow-up measurements were available for 194 injections. The indication for initiating therapy was choroidal neovascularization from age-related macular degeneration (49 eyes), diabetic macular edema (ME) (13 eyes), proliferative diabetic retinopathy (4 eyes), ME attributable to retinal vein occlusion (2 eyes), and ME attributable to autoimmune retinopathy (2 eyes). The mean VA before each injection was 20/96 and at the next follow-up was 20/91 (P = .40). One patient had a painless, culture-negative endophthalmitis in 1 eye 3 days after bilateral bevacizumab; at 1 year VA improved from 20/400 to 20/80. CONCLUSIONS: Simultaneous bilateral intravitreal injections in the office are well tolerated. A separate povidone-iodine preparation, speculum, needle, and syringe were used for each eye. None of the patients requested alternating unilateral injections, after receiving bilateral injections. Patients should be counseled as to the risk of complications.

Brubaker JW, Mohney BG, Pulido JS. · Department of Ophthalmology, University of Utah School of Medicine, Salt Lake City, Utah, USA. · Ophthalmic Genet. · Pubmed #19172512 No free full text.

Abstract: PURPOSE: To report the findings of cystoid macular edema in a patient with chronic progressive external ophthalmoplegia and other systemic features of mitochondrial myopathy. DESIGN: Observational case report. METHODS: Retrospective review of the ophthalmic examination and genetic studies of a patient with chronic progressive ophthalmoplegia. RESULTS: Fundus photos, retinal optical coherence tomography, and fluorescein angiography were significant for findings consistent with bilateral cystoid macular edema, which were found to have resolved after 18 months without treatment. The medical examination supported the diagnosis of chronic progressive external ophthalmoplegia. Fundus photos, retinal optical coherence tomography, and fluorescein angiography were significant for findings consistent with cystoid macular edema. CONCLUSIONS: This case demonstrates the occurrence CME in a patient with CPEO and additional systemic features.

Erie JC, Good JA, Butz JA, Pulido JS. · Department of Ophthalmology Mayo Clinic, Rochester, Minnesota, USA. · Am J Ophthalmol. · Pubmed #18848316 No free full text.

Abstract: PURPOSE: To measure zinc and copper levels in the retinal pigment epithelium (RPE) and choroid complex and in the neural retina in subjects with and without age-related macular degeneration (AMD). DESIGN: Laboratory investigation. METHODS: Eighty-eight donor eyes (44 subjects) were analyzed. After retinal dissection, the RPE and choroid complex was photographed. Using the Minnesota Grading System (MGS), the RPE and choroid complex was classified into 1 of 4 stages as defined by the Age-Related Eye Disease Study. Subjects without AMD were defined as both eyes having MGS stage 1; subjects with AMD were defined as both eyes having MGS stages 2 through 4. Zinc and copper levels were determined by using an inductively coupled plasma-mass spectrometer. Metal levels from two eyes of the same subject were averaged and treated as one observation. Differences in metal levels were examined by using Wilcoxon rank-sum tests. RESULTS: The mean RPE and choroid complex zinc level in subjects with AMD (+/- standard deviation, 223.7 +/- 94.0 microg/g; n = 15) was reduced 24% when compared with that of subjects without AMD (292.1 +/- 98.5 microg/g; n = 29; P = .01). The mean RPE and choroid complex copper level in subjects with AMD (5.1 +/- 1.1 microg/g) was reduced 23% when compared with that of subjects without AMD (6.6 +/- 1.4 microg/g; P = .002). No difference was detected in retinal zinc and copper levels in subjects with and without AMD (P > .09). CONCLUSIONS: Reduced RPE and choroid complex zinc and copper levels in AMD eyes combined with previous information that oral supplementation of zinc plus copper reduces the risk of progression of AMD suggests that metal homeostasis plays a role in AMD and in retinal health.

Ezzat MK, Hann CR, Vuk-Pavlovic S, Pulido JS. · Department of Ophthalmology, Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN 55905, USA. · Br J Ophthalmol. · Pubmed #18577650 No free full text.

Abstract: AIM: To characterise the leucocytes in human macular choroid with and without drusen, and in eyes with advanced age-related macular degeneration (AMD) with fibrovascular scarring (FVS). METHODS: Ten eyes from nine donors (range 55-91 years of age) were obtained from an eye bank within 38 h post mortem. Fixed macular biopsies were sectioned, stained immunochemically and examined for the presence of leucocyte antigens CD45, CD4, CD8, CD14 and CD83. RESULTS: Four eyes without drusen, four eyes with drusen and two eyes with FVS contained 23.9 (SD 6.2)%, 27.5 (7.2)%, and 19.3 (11.3)% CD45-positive cells, respectively. The corresponding percentages for CD4-positive cells were 5.4 (4.3), 8.9 (3.0) and 7.5 (8.1); for CD8-positive cells, 3.8 (0.7), 6.8 (2.2) and 6.3 (2.1); and for CD14-positive cells, 3.7 (3.7), 3.6 (1.6) and 2.6 (3.6), respectively. The authors found CD83-positive cells solely in one of the two FVS eyes examined that had the more severe form of scarring. CONCLUSION: Human choroid contains similar amounts of CD4-positive cells and monocytes irrespective of the presence of drusen, but CD8-positive cells are more abundant in macular choroid with drusen. The presence of haematopoietic cells in the macular choroid provides further evidence for the possible participation of inflammatory cells in pathogenesis of AMD.

Diago T, Pulido JS, Molina JR, Collett LC, Link TP, Ryan EH. · Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. · Mayo Clin Proc. · Pubmed #18241635 links to  free full text

Abstract: Angiogenesis is a common factor in the pathogenesis of cancer and in exudative age-related macular degeneration (AMD). Therefore, angiogenesis inhibition has been developed as a therapeutic strategy. We report 2 cases of recurrent exudative AMD in which oral sorafenib, a tyrosine kinase inhibitor approved for cancer, was added to intravitreal ranibizumab, an antibody to vascular endothelial growth factor. These 2 patients were followed up by determination of visual acuity, fluorescein angiography, fundoscopy, and optical coherence tomography. The visual acuity of 1 patient improved from 20/70 to 20/60 while he was receiving sorafenib therapy; that of the other did not. Marked improvement was noted in both patients on optical coherence tomography. Additionally, both patients appeared to receive some benefit when low-dose oral sorafenib was used as monotherapy after its initial addition to ranibizumab therapy. Randomized trials of adding sorafenib to standard therapy for patients with neovascular AMD should be considered.

Pulido JS, Peterson LM, Mutapcic L, Bryant S, Highsmith WE. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. · Ophthalmic Genet. · Pubmed #18161619 No free full text.

Abstract: PURPOSE: To confirm association of the complement factor H allelic variant (CFH Y402H) and the LOC387715/HTRA1 (LOC387715 A69S) risk alleles with age-related macular degeneration (AMD). STUDY POPULATION: Study of 89 Caucasian patients with neovascular (exudative) AMD and 232 Caucasian controls. METHODS: The Y402H variant of CFH gene and A69S variant of LOC387715/HTRA1 gene locus were examined. RESULTS: For CFH, the odds ratio for the homozygous variant was 4.97 (CI 2.52 to 9.79). For LOC387715/HTRA1 the odds ratio for the homozygous risk variant was 7.75 (CI 3.46 to 17.35). The odds ratio for heterozygous carriers was 3.35 (CI 1.91 to 5.90).

Solano JM, Bakri SJ, Pulido JS. · Mayo Clinic, Rochester, MN 55905, USA. · Can J Ophthalmol. · Pubmed #17823640 links to  free full text

Abstract: CASE REPORT: A 59-year-old patient with a coexisting primary choroidal melanoma and colorectal cancer was treated with external beam radiation (EBR) of his choroidal melanoma and systemic chemotherapy with leukovorin/5 fluorouracil (FU) for treatment of his metastatic colorectal cancer. Eight months following EBR, he showed evidence of radiation retinopathy with macular edema. Optical coherence tomography (OCT) showed macular edema and subretinal fluid. Subsequently, systemic bevacizumab (5 mg/kg) was added to his leukovorin/5FU chemotherapy. After the addition of bevacizumab, OCT showed complete resolution of the macular edema and subretinal fluid. COMMENTS: Bevacizumab may have a role in the treatment of radiation retinopathy, but further investigation is needed before any definitive conclusions can be made.

Erie JC, Good JA, Butz JA, Hodge DO, Pulido JS. · Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. · Am J Ophthalmol. · Pubmed #17631267 No free full text.

Abstract: PURPOSE: To evaluate the association between urinary and blood cadmium (Cd) levels with age-related macular degeneration (AMD). DESIGN: Prospective case-control study. METHODS: In 53 participants older than 60 years with AMD in both eyes and in 53 age-matched (+/- 3 years) controls without AMD, Cd levels were measured in blood and urine specimens (with and without creatinine adjustment) by using inductively coupled plasma-mass spectrometry. Data on age, gender, smoking status, and family history were obtained. By using color stereoscopic fundus photographs, the degree of AMD was graded using the Age-Related Eye Disease Study's 4-stage AMD severity scale. The inclusion criterion for AMD cases was a photographic severity level of two to four in both eyes. Median blood and urine Cd and median urine Cd/creatinine concentrations in cases and controls were compared by using the rank-sum test, stratifying for smoking status. RESULTS: Current and former smokers with AMD had median urine Cd/creatinine levels (1.18 microg/g; range, 0.84 to 1.44 microg/g) that were 97% higher than smokers without AMD (0.60 microg/g; range, 0.49 to 0.90 microg/g; P = .02), 111% higher than never smokers with AMD (0.56 microg/g; range, 0.40 to 0.80 microg/g; P < .001) and 107% higher than never smokers without AMD (0.57 microg/g; 0.40 to 0.65 microg/g; P < .001). Blood Cd levels, indicative of short-term exposure levels, were not associated with AMD (P >/= .06). CONCLUSIONS: A higher urinary Cd level, which reflects the total body burden of Cd, was associated with AMD in smokers. Accumulated Cd exposure may be important in the development of smoking-related AMD.

Amselem L, Montero J, Diaz-Llopis M, Pulido JS, Bakri SJ, Palomares P, Garcia-Delpech S. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. · Am J Ophthalmol. · Pubmed #17601432 No free full text.

Abstract: PURPOSE: To determine whether bevacizumab may improve anatomic and visual outcomes in patients with ocular ischemic syndrome (OIS). DESIGN: Interventional case reports. METHODS: Two patients with OIS presenting with unilateral ocular pain, iris neovascularization, and macular edema. Intravitreal injection of bevacizumab (1.25 mg). The main outcome measures were postinjection best-corrected visual acuity (BCVA), intraocular pressure (IOP), angiographic findings, and optical coherence tomography (OCT) findings and complications. RESULTS: One week after treatment, both patients demonstrated regression of the iris neovascularization and improvement of the macular edema, with no changes in BCVA and IOP. One eye was reinjected at four months. After three and seven months, no significant or systemic adverse events were observed, and no signs of new iris neovascularization were present. CONCLUSIONS: Intravitreal bevacizumab may be useful for the treatment of eyes with iris neovascularization and macular edema secondary to OIS.

Pulido JS, Winters JL, Boyer D. · Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. · Trans Am Ophthalmol Soc. · Pubmed #17471343 links to  free full text

Abstract: PURPOSE: To present an initial evaluation of the final data from the Multicenter Investigation of Rheopheresis for age-related macular degeneration (AMD) (MIRA-1) trial. This was a 12-month randomized, prospective, multicenter, double-masked, placebo-controlled, Food and Drug Administration approved clinical trial designed to compare rheopheresis treatment with placebo-control treatment. METHODS: Patients that had nonexudative age-related macular degeneration (AMD) and certain hemorheologic abnormalities were randomized to either rheopheresis or sham treatment in a 2:1 fashion. Best-corrected visual acuity was determined before and at 3, 6, 9, and 12 months following treatment. Adverse events were also recorded. RESULTS: A total of 216 patients were randomized. Of these, 18 were not included in the vision or adverse events evaluation because they did not complete one treatment. This decreased the number of patients that were evaluated for adverse events to 198 patients. In this group, there were 27 serious adverse events, but only 1.8 % of treatments were suspended because of adverse events. At 12 months, there were 104 treated patients and 63 placebo patients that had follow-up. The treated patients had a logMAR vision improvement of 0.02 +/- 0.213, and the placebo patients had a vision improvement of 0.02 +/- 0.20. This was not statistically significant (P = .977). The repeated measure P value for the entire time interval was not significant (P = .69). There appeared to be patients entered into the study that did not meet inclusion criteria. Excluding 37% of the treated patients and 29% of the placebo data from the analysis, there appeared to be statistically significant improvement in the treated patients compared to the control patients at 1 year with a P value of .001 (repeated measures P value = .01). CONCLUSIONS: At best this was a flawed study in that 37% of the treated cases did not meet inclusion criteria, and at worst there was no evidence of effect. Even though the number of serious adverse events is small, because this study did not show an effect in the intent-to-treat group, rheopheresis should not be performed for AMD outside of an approved randomized controlled trial.

Pulido JS, McConnell JP, Lennon RJ, Bryant SC, Peterson LM, Berger PB, Somers V, Highsmith WE. · Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. · Mayo Clin Proc. · Pubmed #17352366 links to  free full text

Abstract: OBJECTIVE: To determine whether either of the gene variants associated with age-related macular degeneration is associated with coronary artery disease (CAD). PATIENTS AND METHODS: This study consisted of 493 patients who underwent clinically indicated coronary angiography between June 1, 1998, and January 1, 1999. The Y402H variant of the complement factor H (CFH) gene and the A69S variant of the LOC387715 gene locus were examined by restriction fragment length polymorphism. Multiple logistic regression models were used to assess the association of CFH and LOC gene variants with CAD. Covariates with well-established associations with CAD were also evaluated. RESULTS: Seventy patients (14%) were homozygous for the histidine variant (HH) of CFH, 237 (48%) were heterozygous for the histidine variant (HY), and 186 (38%) were homozygous for the tyrosine variant (YY). Three hundred eight patients (62%) were homozygous for the alanine allele of LOC387715, 170 (34%) were heterozygous for Ala and Ser alleles, and 15 (3%) were homozygous for the serine variant. The overall association of the CFH genotype with CAD was not statistically significant (P=.08). However, some evidence (P=-.046) suggested that CAD was increased for the HH genotype compared to the homozygous wild-type YY genotype (odds ratio, 1.95; 95% confidence interval, 1.01-3.76). Male sex, hypertension, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and age were other variables that demonstrated significant associations with CAD. The overall effect of the LOC genotype was not statistically significant (P=-.06). Heterozygosity for the serine variant was (P=-.02) associated with the absence of CAD vs the AS genotype (odds ratio, 0.59; confidence interval, 0.38-0.91; P=-.02). CONCLUSION: The CFH genotype may have an independent association with CAD, although our evidence did not show statistical significance. Controlling for known risk factors, the age-related macular degeneration-associated HH variant appears to be associated with CAD. The LOC387715 gene may also play a role in CAD.

Suh DW, Pulido JS, Jampol LM, Chong LP, Thomas M. · Eye Institute, Medical College of Wisconsin, Milwaukee, USA. · Retina. · Pubmed #10048380 No free full text.

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Amselem L, Pulido JS, Diaz-Llopis M, Cervera E, Montero J. · No affiliation provided · Eye. · Pubmed #17259917 No free full text.

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Pulido JS. · No affiliation provided · Arch Ophthalmol. · Pubmed #17102026 No free full text.

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Pulido JS, Winters J. · No affiliation provided · J Clin Apher. · Pubmed #16106452 No free full text.

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Pulido JS, Blake CR. · No affiliation provided · Arch Ophthalmol. · Pubmed #15078692 No free full text.

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Shahidi M, Blair NP, Mori M, Gieser J, Pulido JS. · No affiliation provided · Br J Ophthalmol. · Pubmed #12034682 links to  free full text

Abstract: AIM: To determine the relation between alterations in the retinal topography and thickness, visual acuity, and retinal pigment epithelium hypopigmentation in atrophic age related macular degeneration (AMD). METHODS: 22 patients, mean age 74 (SD 8) years, with atrophic AMD were recruited. An optical imaging system based on the retinal thickness analyser (RTA) was applied to generate a series of 20 optical section images that encompass 2 mm x 2 mm retinal areas. The optical section images were digitised and analysed to provide topographic maps of the vitreoretinal and chorioretinal surfaces and the retinal thickness. Vitreoretinal and chorioretinal surface elevations and retinal thickness were determined. RESULTS: Variation in the vitreoretinal surface height was moderately correlated with visual acuity (r = -0.4; p = 0.03; n = 22). Increase in variation of chorioretinal surface height was correlated with decrease in visual acuity (r = -0.5; p = 0.01; n = 22). The retinal thickness was not associated with visual acuity (r = 0.2; p = 0.2; n=22). Relative height of the vitreoretinal surface in eyes with retinal pigment epithelium (RPE) hypopigmentation was significantly less than eyes without RPE hypopigmentation (p = 0.005). Eyes with and without RPE hypopigmentation had a similar relative height of the chorioretinal surface (p = 0.4). Retinal thickness in eyes with RPE hypopigmentation was less than in eyes without RPE hypopigmentation (p = 0.04). CONCLUSION: Mapping of chorioretinal and vitreoretinal topography and retinal thickness provides objective and quantitative measurements of retinal structural abnormalities and shows promise as an adjunct for the evaluation of retinal structural changes due to AMD.