Keane Pearse A, de Salvo Gabriella, Sim Dawn A, Goverdhan Srini, Agrawal Rupesh, Tufail Adnan
NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Clin Ophthalmol. 2015 Feb 17;9:353-66. doi: 10.2147/OPTH.S59012. eCollection 2015.
Treatment of the neovascular form of age-related macular degeneration (AMD) has been revolutionized by the introduction of such agents as ranibizumab, bevacizumab, and aflibercept. As a result, the incidence of legal blindness occurring secondary to AMD has fallen dramatically in recent years in many countries. While these agents have undoubtedly been successful in reducing visual impairment and blindness, patients with neovascular AMD typically lose some vision over time, and often lose the ability to read, drive, or perform other important activities of daily living. Efforts are therefore under way to develop strategies that allow for earlier detection and treatment of this disease. In this review, we begin by providing an overview of the rationale for, and the benefits of, early detection and treatment of neovascular AMD. To achieve this, we begin by providing an overview of the pathophysiology and natural history of choroidal neovascularization, before reviewing the evidence from both clinical trials and "real-world" outcome studies. We continue by highlighting an area that is often overlooked: the importance of patient education and awareness for early AMD detection. We conclude the review by reviewing an array of both established and emerging technologies for early detection of choroidal neovascularization, ranging from Amsler chart testing, to hyperacuity testing, to advanced imaging techniques, such as optical coherence tomography.
诸如雷珠单抗、贝伐单抗和阿柏西普等药物的引入，彻底改变了新生血管性年龄相关性黄斑变性（AMD）的治疗方法。因此，近年来在许多国家，由AMD继发的法定失明发生率大幅下降。虽然这些药物在减少视力损害和失明方面无疑取得了成功，但新生血管性AMD患者通常会随着时间的推移而丧失一些视力，并且常常失去阅读、驾驶或进行其他重要日常生活活动的能力。因此，人们正在努力制定策略，以便更早地检测和治疗这种疾病。在本综述中，我们首先概述新生血管性AMD早期检测和治疗的基本原理及益处。为实现这一目标，我们首先概述脉络膜新生血管形成的病理生理学和自然病程，然后回顾临床试验和“真实世界”结局研究的证据。我们接着强调一个经常被忽视的领域：患者教育和意识对于早期AMD检测的重要性。我们通过回顾一系列用于早期检测脉络膜新生血管形成的成熟和新兴技术来结束本综述，这些技术从阿姆斯勒表测试到超视力测试，再到先进的成像技术，如光学相干断层扫描。
