Klein Ronald, Klein Barbara E K, Tomany Sandra C, Meuer Stacy M, Huang Guan-Hua
Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin 53726-2397, USA.
Ophthalmology. 2002 Oct;109(10):1767-79. doi: 10.1016/s0161-6420(02)01146-6.
The aim of the study was to describe the 10-year incidence and progression of retinal drusen, retinal pigmentary abnormalities, and signs of late age-related maculopathy.
Population-based cohort study.
The study included 4926 persons, 43 to 86 years of age at the time of a baseline examination from 1988 through 1990, living in Beaver Dam, Wisconsin, of whom 3684 participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up.
Characteristics of drusen and other lesions typical of age-related maculopathy were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System.
Incidence of drusen type and size, pigmentary abnormalities, geographic atrophy, and exudative degeneration.
The 10-year incidence of early age-related maculopathy was 12.1% and of late age-related maculopathy it was 2.1%. There was a statistically significant increased incidence of age-related maculopathy lesions with age (P < 0.05). Individuals 75 years of age or older at baseline had significantly (P < 0.01) higher 10-year incidences of the following characteristics than people 43 to 54 years of age: larger sized drusen (125 micro m-249 micro m, 26.3% vs. 3.3%; > or =250 micro m, 16.2% vs. 1.0%), soft indistinct drusen (22.2% vs. 2.2%), retinal pigment abnormalities (19.5% vs. 0.8%), exudative macular degeneration (4.1% vs. 0%), and pure geographic atrophy (3.1% vs. 0%). Compared with those with small numbers of only small, hard drusen (1-2), those with large numbers of only hard drusen (8 or more) had an increased 10-year incidence of both soft drusen (12.3% vs. 6.7%) and pigmentary abnormalities (4.9% vs. 1.7%). Eyes with soft indistinct drusen or retinal pigmentary abnormalities at baseline, were more likely to develop late age-related macular degeneration at follow-up than eyes without these lesions (15.1% vs. 0.4% and 20.0% vs. 0.8%, respectively).
These population-based estimates document the high incidence of signs of age-related maculopathy in people 75 years of age or older. Our findings demonstrate that large numbers of hard drusen predict the incidence of soft drusen and pigmentary abnormalities and that the presence of the latter lesions significantly increases the risk for the development of geographic atrophy and exudative macular degeneration.
本研究旨在描述视网膜玻璃膜疣、视网膜色素异常及晚期年龄相关性黄斑病变体征的10年发病率及进展情况。
基于人群的队列研究。
本研究纳入了4926人，他们在1988年至1990年基线检查时年龄为43至86岁，居住在威斯康星州比弗迪尔，其中3684人参与了5年随访检查，2764人参与了10年随访。
使用威斯康星年龄相关性黄斑病变分级系统对立体彩色眼底照片进行分级，以确定玻璃膜疣及其他年龄相关性黄斑病变典型病变的特征。
玻璃膜疣类型和大小、色素异常、地图样萎缩及渗出性变性的发病率。
早期年龄相关性黄斑病变的10年发病率为12.1%，晚期年龄相关性黄斑病变为2.1%。年龄相关性黄斑病变病变的发病率随年龄增长有统计学显著增加（P < 0.05）。基线时75岁及以上的个体，以下特征的10年发病率显著高于43至54岁的人群（P < 0.01）：较大尺寸的玻璃膜疣（125μm - 249μm，26.3%对3.3%；≥250μm，16.2%对1.0%）、软性边界不清的玻璃膜疣（22.2%对2.2%）、视网膜色素异常（19.5%对0.8%）、渗出性黄斑变性（4.1%对0%）及单纯地图样萎缩（3.1%对0%）。与仅有少量小而硬玻璃膜疣（1 - 2个）的人相比，仅有大量硬玻璃膜疣（8个或更多）的人软性玻璃膜疣（12.3%对6.7%）和色素异常（4.9%对1.7%）的10年发病率均增加。基线时具有软性边界不清玻璃膜疣或视网膜色素异常的眼睛，在随访时比无这些病变的眼睛更易发生晚期年龄相关性黄斑变性（分别为15.1%对0.4%和20.0%对0.8%）。
这些基于人群的估计记录了75岁及以上人群中年龄相关性黄斑病变体征的高发病率。我们的研究结果表明，大量硬玻璃膜疣可预测软性玻璃膜疣和色素异常的发病率，而后两者病变的存在显著增加了发生地图样萎缩和渗出性黄斑变性的风险。
