UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Ophthalmology. 2012 Jul;119(7):1432-7. doi: 10.1016/j.ophtha.2012.02.048. Epub 2012 May 1.
To use longitudinal quantitative morphologic and visual acuity (VA) data to investigate the risk of choroidal neovascularization (CNV) event occurrence in eyes with dry age-related macular degeneration (AMD).
Prospective observational study.
A total of 513 participants (844 eyes) followed longitudinally in one center enrolled in the Age-Related Eye Disease Study (AREDS) or the Prophylactic Treatment of AMD Study (PTAMD).
We assessed images of previously obtained fundus photographs for the presence of macular pigmentation, drusen area, and drusen distribution (number and size), and fellow eye CNV status at baseline. Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity at each visit and the age of each subject were obtained. We used a longitudinal logistic mixed-effects model with random intercepts fitted to event occurrences to assess risk on a per eye basis.
Odds ratios for CNV event.
Thirty-one subjects (6.0%) had events. Only VA changes over time and follow-up interval showed statistically significant effects. Several statistical models that included VA at the previous visit were used. In 2 models, 3 categories of VA were used: ≤ 75 letters, >75 and ≤ 85 letters, and >85 letters. Two categories were used for follow-up: ≤ 3 years versus >3 years or ≤ 1 year versus >1 year. In the first model with categorization at 3 years, a decrease in acuity from the >85 letter category to ≤ 75 letters increased the odds of CNV by 16.9 times (P = 0.022). In the model with categorization at 1 year, a decrease in acuity from the >85-letter category to ≤ 75 letters increased the odds of CNV by 21.4 times (P = 0.0175). Differences between the follow-up intervals were significant (P = 0.043) and indicated a more than 7-fold increase in the odds. Changes in morphologic features of the macula did not show significant effects.
A decrease in VA to ≤ 75 ETDRS letters in an eye with an initial ETDRS baseline acuity of >85 letters increases the likelihood of CNV by approximately 20-fold. This likelihood also increases with aging.
利用纵向定量形态学和视力（VA）数据来研究干性年龄相关性黄斑变性（AMD）患者发生脉络膜新生血管（CNV）事件的风险。
前瞻性观察研究。
共有 513 名参与者（844 只眼）在一个中心进行了纵向随访，他们参加了年龄相关性眼病研究（AREDS）或 AMD 预防性治疗研究（PTAMD）。
我们评估了之前获得的眼底照片中的黄斑色素、玻璃膜疣面积和玻璃膜疣分布（数量和大小）以及对侧眼 CNV 状态的图像，在基线时。每次就诊时我们都会获取早期糖尿病性视网膜病变研究（ETDRS）最佳矫正视力和每位受试者的年龄。我们使用纵向逻辑混合效应模型，带有随机截距，根据每只眼的事件发生情况进行拟合，以评估风险。
CNV 事件的比值比。
31 名受试者（6.0%）发生了事件。只有 VA 随时间和随访间隔的变化显示出统计学上的显著影响。我们使用了几个包含前一次就诊时 VA 的统计模型。在 2 个模型中，VA 分为 3 个类别：≤75 个字母、>75 和≤85 个字母、>85 个字母。随访时间也分为两类：≤3 年与>3 年或≤1 年与>1 年。在 3 年分类的第一个模型中，从>85 个字母类别到≤75 个字母的视力下降使 CNV 的几率增加了 16.9 倍（P=0.022）。在 1 年分类的模型中，从>85 个字母类别到≤75 个字母的视力下降使 CNV 的几率增加了 21.4 倍（P=0.0175）。随访间隔的差异具有统计学意义（P=0.043），表明几率增加了 7 倍以上。黄斑形态特征的变化没有显示出显著的影响。
初始 ETDRS 视力基线大于 85 个字母的眼 VA 下降至≤75 ETDRS 字母，使 CNV 的可能性增加了近 20 倍。这种可能性也随着年龄的增长而增加。
