Department of Ophthalmology, University of Bonn, Bonn, Germany.
Institute of Ophthalmology, University College London, London, England.
JAMA Ophthalmol. 2015 Jun;133(6):690-7. doi: 10.1001/jamaophthalmol.2015.0477.
IMPORTANCE: Clinical observations suggest that patients with age-related macular degeneration (AMD) have vision problems, particularly in dim light conditions. Previous studies on structural-functional analysis in patients with AMD with reticular drusen (RDR) have focused on photopic sensitivity testing but have not specifically assessed scotopic function. OBJECTIVE: To evaluate retinal function by scotopic and photopic microperimetry in patients with AMD and a well-demarcated area of RDR. DESIGN, SETTING, AND PARTICIPANTS: Prospective case series in a referral center of 22 eyes from 18 patients (mean age, 74.7 years; range, 62-87 years). The study was conducted from June 1, 2014, to October 31, 2014. INTERVENTIONS: With the use of combined confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography imaging, retinal areas with RDR (category 1) and no visible pathologic alterations (category 2) were identified in each eye. Scotopic and photopic microperimetry (MP-1S; Nidek Technologies) was performed using a grid with 56 stimulus points. MAIN OUTCOMES AND MEASURES: Comparison of mean threshold sensitivities for each category for scotopic and photopic microperimetry. RESULTS: In all eyes, areas of category 1 showed a relative and sharply demarcated reduction of scotopic threshold values compared with areas of category 2, but only less-pronounced differences were seen for photopic testing. Statistical analysis in the 18 eyes in which the 1.0-log unit neutral density filter was applied revealed a difference of scotopic threshold values in areas of category 1 (mean, 13.5 dB [95% CI, 12.1-15.0]) vs category 2 (mean, 18.3 dB; [95% CI, 17.4-19.3] (P ≤ .001). For photopic testing, the mean threshold values were 16.8 dB (95% CI, 15.5-18.2) in category 1 and 18.4 dB (95% CI, 17.1-19.6) in category 2 (P = .03). CONCLUSIONS AND RELEVANCE: The results of this study suggest that rod function is more severely affected than cone function in retinal areas with RDR. This differential structural-functional correlation underscores the functional relevance of RDR in patients with AMD.
重要性：临床观察表明，年龄相关性黄斑变性（AMD）患者存在视力问题，尤其是在暗光环境下。先前对具有网状渗出（RDR）的 AMD 患者的结构-功能分析研究主要集中在明视敏度测试上，但并未专门评估暗视功能。 目的：通过暗视和明视微视野计评估 AMD 患者和明确界定的 RDR 区域的视网膜功能。 设计、地点和参与者：这是一项于 2014 年 6 月 1 日至 2014 年 10 月 31 日在一个转诊中心进行的前瞻性病例系列研究，共纳入 18 名患者的 22 只眼（平均年龄 74.7 岁；范围 62-87 岁）。 干预措施：使用共焦扫描激光检眼镜和频域光学相干断层扫描成像，在每只眼中识别出具有 RDR（类别 1）和无可见病理改变（类别 2）的视网膜区域。使用具有 56 个刺激点的网格进行暗视和明视微视野计（MP-1S；尼德克技术公司）。 主要结局和测量指标：比较暗视和明视微视野计中每个类别的平均阈值敏感度。 结果：在所有眼中，与类别 2 相比，类别 1 区域的暗视阈值明显且急剧降低，但明视测试的差异较小。对应用 1.0 对数单位中性密度滤光片的 18 只眼中进行统计学分析，结果显示类别 1 区域的暗视阈值存在差异（平均为 13.5dB [95%CI，12.1-15.0]），而类别 2 区域的暗视阈值为 18.3dB [95%CI，17.4-19.3]（P≤.001）。明视测试时，类别 1 的平均阈值为 16.8dB（95%CI，15.5-18.2），类别 2 的平均阈值为 18.4dB（95%CI，17.1-19.6）（P=.03）。 结论和相关性：这项研究的结果表明，在具有 RDR 的视网膜区域，杆状功能的受损程度比锥状功能更为严重。这种结构-功能的差异相关性强调了 RDR 在 AMD 患者中的功能相关性。
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