Cuticular drusen in Asian neovascular age-related macular degeneration: Clinical features and polypoidal choroidal vasculopathy association.

PURPOSE: To characterize the clinical features of cuticular drusen (CD) in Asian patients with neovascular age-related macular degeneration (nAMD), and to evaluate its association with polypoidal choroidal vasculopathy (PCV) and the risk of macular neovascularization (MNV). METHODS: Baseline multimodal images from a prospective Asian nAMD cohort were analyzed. Patients were classified into cuticular drusen (CD), soft drusen (SD), or no drusen (ND) groups based on multimodal imaging. Patients were assigned to the CD group if CD was present in either eye, regardless of the presence of other drusen types. Patients without CD but with SD in one or both eyes were assigned to the SD group. Patients with no drusen in either eye were assigned to the ND group. Clinical and imaging features were compared. MNV lesions were subtyped as PCV or typical nAMD. For eyes without MNV at baseline, the 5-year cumulative incidence of MNV was estimated using Kaplan–Meier analysis. RESULTS: A total of 104 patients (173 eyes) were included: 16 with CD (21 eyes), 43 with SD (62 eyes), and 45 with ND (90 eyes). CD patients were older (75.5 ± 9.1 years) compared to ND patients (66.2 ± 7.4 years, p < 0.001). There was no significant difference in gender distribution between patients with CD, SD and ND. CD eyes had shorter axial length than ND (p = 0.004) and commonly coexisted with large (> 200 μm) soft/ colloid drusen (66.7%) and subretinal drusenoid deposits (33.3%). MNV was present in 52.3% of CD eyes, with 54.5% classified as PCV, which was intermediate to SD (25.0%) and ND (74.5%). Among CD eyes without baseline MNV, the 5-year incidence was 11.1%, also intermediate to ND (0.0%) and SD (38.2%). CONCLUSION: In this Asian nAMD cohort, patients with CD were older with a more balanced gender distribution. Its notable association with PCV and MNV risk highlights the need for continued monitoring and further investigation.