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. 2021 Sep 14;11:18227. doi: 10.1038/s41598-021-97771-w

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© The Author(s) 2021

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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(A, B) Example of a 70-year-old female reticular pseudodrusen (RPD) patient that developed a significant increase in RPD-affected area over the 5-year follow-up yet no late-stage form of age-related macular degeneration. (A) Baseline. Above near-infrared confocal scanning laser ophthalmoscopy (cSLO) image showing hyporeflective dots superiorly located to the fovea. Rectangle marks the area magnified below. Grey dotted line marks the location of the optical coherence tomography (OCT) scan below. (B) Same eye after 5 years. Note the increase in RPD-affected area and the increase in lesion density visible both in the cSLO en-face image above as well as in the magnified image. The OCT scans reveal early RPD stages at baseline and predominantly stage-three RPD lesions at 5-year follow-up. Also note signs of incomplete outer retinal atrophy in (B). There is detritus on the intact RPE monolayer with remnants of the ellipsoid zone but no hypertransmission. Individual RPD lesions are harder to discern. (C, D) Example of a 71-year-old female RPD patient that developed geographic atrophy over the 5-year follow-up. (C) Baseline. (D) Same eye after 5 years. Note the perifoveal patches of geographic atrophy and a moderate increase in RPD-affected area and lesion density. The OCT scan appears rather similar to the baseline image without any signs of outer retinal atrophy.