Progression of choriocapillaris flow deficit in eyes with drusenoid pigment epithelial detachment.

PURPOSE: To quantitatively evaluate choriocapillaris flow deficits (CCFD) in eyes with drusenoid pigment epithelial detachment (PED) and examine their associations with disease progression and visual outcomes. METHODS: This retrospective longitudinal cohort study included 42 eyes with drusenoid PED. Choriocapillaris flow deficit percentage (CCFD%) was quantified using compensation-corrected OCTA imaging with standardized thresholding algorithms. Longitudinal changes in CCFD%, risk factors for geographic atrophy (GA) progression, and predictors of final best-corrected visual acuity (BCVA) were analyzed. RESULTS: Mean baseline CCFD% was 36.26 ± 5.06%, with gradual worsening over 4 years to 38.47 ± 5.34% (0.60 ± 2.06%/year, P = .012). Eyes progressing to GA demonstrated significantly higher baseline CCFD% than stable eyes (37.94 ± 2.31% vs. 35.12 ± 6.07%, P < .001). During follow-up, 17 eyes (40.5%) developed GA, 23 (54.8%) remained stable, and 2 (4.8%) progressed to neovascular AMD. Multivariate Cox regression identified baseline CCFD (HR, 1.804; P = 0.006) and annual CCFD change rate (HR, 2.262; P = .024) as independent risk factors for GA progression. Multiple linear regression demonstrated that baseline CCFD and CCFD change rate independently predicted final BCVA (adjusted R2 = 0.961, P < .001). CONCLUSIONS: Both baseline CCFD and progressive CCFD deterioration serve as independent predictors of anatomical and functional outcomes in drusenoid PED, emphasizing the pathophysiological role of choroidal hemodynamic dysfunction in AMD progression.