Schmitz-Valckenberg Steffen, Sadda Srinivas, Staurenghi Giovanni, Chew Emily Y, Fleckenstein Monika, Holz Frank G
*Department of Ophthalmology, GRADE Reading Center, University of Bonn, Bonn, Germany; †Deparment of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California; ‡Department of Biomedical and Clinical Sciences "Luigi Sacco," Eye Clinic, Luigi Sacco Hospital, University of Milan, Milan, Italy; and §Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Retina. 2016 Dec;36(12):2250-2264. doi: 10.1097/IAE.0000000000001258.
There is a lack of agreement regarding the types of lesions and clinical conditions that should be included in the term "geographic atrophy." Varied and conflicting views prevail throughout the literature and are currently used by retinal experts and other health care professionals.
We reviewed the nominal definition of the term "geographic atrophy" and conducted a search of the ophthalmologic literature focusing on preceding terminologies and the first citations of the term "geographic atrophy" secondary to age-related macular degeneration.
According to the nominal definition, the term "geography" stands for a detailed description of the surface features of a specific region, indicating its relative position. However, it does not necessarily imply that the borders of the region must be sharply demarcated or related to any anatomical structures. The term "geographical areas of atrophy" was initially cited in the 1960s in the ophthalmologic literature in the context of uveitic eye disease and shortly thereafter also for the description of variants of "senile macular degeneration." However, no direct explanation could be found in the literature as to why the terms "geographical" and "geographic" were chosen. Presumably the terms were used as the atrophic regions resembled the map of a continent or well-defined country borders on thematic geographical maps. With the evolution of the terminology, the commonly used adjunct "of the retinal pigment epithelium" was frequently omitted and solely the term "geographic atrophy" prevailed for the nonexudative late-stage of age-related macular degeneration itself. Along with the quantification of atrophic areas, based on different imaging modalities and the use of both manual and semiautomated approaches, various and inconsistent definitions for the minimal lesion diameter or size of atrophic lesions have also emerged.
Reconsideration of the application of the term "geographic atrophy" in the context of age-related macular degeneration seems to be prudent given ongoing advances in multimodal retinal imaging technology with identification of various phenotypic characteristics, and the observation of atrophy development in eyes under antiangiogenic therapy.
对于“地图样萎缩”一词应涵盖的病变类型和临床情况，目前尚无统一意见。文献中存在各种不同且相互矛盾的观点，视网膜专家和其他医疗保健专业人员目前也在使用这些观点。
我们回顾了“地图样萎缩”一词的名义定义，并检索了眼科文献，重点关注先前的术语以及年龄相关性黄斑变性继发的“地图样萎缩”一词的首次引用。
根据名义定义，“地图”一词代表对特定区域表面特征的详细描述，表明其相对位置。然而，这并不一定意味着该区域的边界必须清晰划定或与任何解剖结构相关。“萎缩性地理区域”一词最初于20世纪60年代在葡萄膜炎性眼病的背景下被眼科文献引用，此后不久也用于描述“老年性黄斑变性”的变体。然而，在文献中未找到关于为何选择“地理的”和“地图样的”这两个术语的直接解释。推测这些术语被使用是因为萎缩区域类似于大陆地图或专题地理地图上定义明确的国界。随着术语的演变，常用的修饰语“视网膜色素上皮的”经常被省略，仅“地图样萎缩”一词用于年龄相关性黄斑变性本身的非渗出性晚期。随着基于不同成像方式以及手动和半自动方法对萎缩区域进行量化，对于萎缩性病变的最小病变直径或大小也出现了各种不一致的定义。
鉴于多模态视网膜成像技术不断进步，可识别各种表型特征，以及在抗血管生成治疗下观察到眼睛萎缩的发展，重新考虑“地图样萎缩”一词在年龄相关性黄斑变性中的应用似乎是谨慎的。
