Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.
Ophthalmology. 2010 Mar;117(3):489-99. doi: 10.1016/j.ophtha.2009.12.002. Epub 2010 Jan 15.
To describe the natural history of eyes with drusenoid pigment epithelial detachments (DPEDs) associated with age-related macular degeneration (AMD).
Multicenter, clinic-based, prospective cohort study.
Among 4757 participants enrolled in the Age-Related Eye Disease Study (AREDS), 255 were identified as having DPED in at least 1 eye and having 5 or more years of follow-up after the initial detection of the DPED.
Baseline and annual fundus photographs were evaluated for the evolution of the fundus features and the development of advanced AMD in the forms of central geographic atrophy (CGA) or neovascular (NV) AMD. Kaplan-Meier analyses of progression to advanced AMD and of moderate vision loss (> or =15 letters compared with baseline) were performed.
Rate of progression to advanced AMD and change in visual acuity from baseline (in terms of mean letters lost and proportion losing > or =15 letters).
A total of 311 eyes (from 255 participants) with DPED were followed for a median follow-up time of 8 years subsequent to the initial detection of a DPED. Of the 282 eyes that did not have advanced AMD at baseline, advanced AMD developed within 5 years in 119 eyes (42%) (19% progressing to CGA and 23% progressing to NV-AMD). In the remaining eyes that did not develop advanced AMD (n=163), progressive fundus changes, typified by the development of calcified drusen and pigmentary changes, were detected. Visual decline was prominent among study eyes, with approximately 40% of all eyes decreasing in visual acuity by > or =15 letters at 5 years follow-up. Mean visual acuity decreased from 76 letters ( approximately 20/30) at baseline to 61 letters ( approximately 20/60) at 5 years. Five-year decreases in mean visual acuity averaged 26 letters for eyes progressing to advanced AMD and 8 letters for non-progressing eyes.
The natural history of eyes containing DPED is characterized by a high rate of progression to both CGA and NV-AMD. Among eyes not progressing to advanced AMD, progressive development of pigmentary changes and calcified drusen were observed. Decline of visual acuity is a common outcome, with or without progression to advanced forms of AMD.
描述与年龄相关性黄斑变性（AMD）相关的玻璃膜疣性色素上皮脱离（DPED）眼的自然病程。
多中心、基于临床的前瞻性队列研究。
在参与年龄相关性眼病研究（AREDS）的 4757 名参与者中，有 255 名被确定为至少 1 只眼存在 DPED，并且在 DPED 首次发现后有 5 年或更长时间的随访。
对基线和每年的眼底照片进行评估，以评估眼底特征的演变和中央性地图状萎缩（CGA）或新生血管（NV）AMD 等晚期 AMD 的发展。对进展为晚期 AMD 和中度视力丧失（与基线相比>或=15 个字母）进行 Kaplan-Meier 分析。
进展为晚期 AMD 的速度和从基线开始的视力变化（以平均丢失的字母数和丢失>或=15 个字母的比例表示）。
共有 311 只眼（来自 255 名参与者）在 DPED 首次发现后中位数为 8 年的时间内进行了随访。在基线时没有晚期 AMD 的 282 只眼中，在 5 年内有 119 只眼（42%）发展为晚期 AMD（19%进展为 CGA，23%进展为 NV-AMD）。在其余未发生晚期 AMD 的 163 只眼中，检测到进行性眼底改变，典型表现为钙化性玻璃膜疣和色素变化的发展。研究眼的视力下降明显，约 40%的眼在 5 年随访时视力下降>或=15 个字母。平均视力从基线时的 76 个字母（约 20/30）下降到 5 年时的 61 个字母（约 20/60）。进展为晚期 AMD 的眼 5 年平均视力下降 26 个字母，非进展眼下降 8 个字母。
含 DPED 的眼的自然病程特征为向 CGA 和 NV-AMD 均有较高的进展率。在未进展为晚期 AMD 的眼中，观察到色素变化和钙化性玻璃膜疣的进行性发展。视力下降是常见的结果，无论是否进展为晚期 AMD。
