Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
EMMES Corporation, Rockville, Maryland.
Ophthalmology. 2017 Apr;124(4):479-487. doi: 10.1016/j.ophtha.2016.12.004. Epub 2017 Jan 12.
To compare rates of peripheral retinal changes in Age-Related Eye Disease Study 2 (AREDS2) participants with at least intermediate age-related macular degeneration (AMD) with control subjects without intermediate age-related changes (large drusen).
Cross-sectional evaluation of clinic-based patients enrolled in AREDS2 and a prospective study.
Participants from prospective studies.
The 200° pseudocolor and fundus autofluorescence (FAF) images were captured on the Optos 200 Tx Ultrawide-field device (Optos, Dunfermline, Scotland) by centering on the fovea and then steering superiorly and inferiorly. The montaged images were graded at a reading center with the images divided into 3 zones (zone 1 [posterior pole], zone 2 [midperiphery], and zone 3 [far periphery]) to document the presence of peripheral lesions.
Peripheral retinal lesions: drusen, hypopigmentary/hyperpigmentary changes, reticular pseudodrusen, senile reticular pigmentary changes, cobblestone degeneration, and FAF abnormalities.
A total of 484 (951 eyes) AREDS2 participants with AMD (cases) and 89 (163 eyes) controls without AMD had gradable color and FAF images. In zones 2 and 3, neovascularization and geographic atrophy (GA) were present, ranging from 0.4% to 6% in eyes of cases, respectively, and GA was present in 1% of eyes of controls. Drusen were detected in 97%, 78%, and 64% of eyes of cases and 48%, 21%, and 9% of eyes of controls in zones 2 and 3 superior and 3 inferior, respectively (P < 0.001 for all). Peripheral reticular pseudodrusen were seen in 15%. Senile reticular pigmentary change was the predominant peripheral change seen in 48% of cases and 16% of controls in zone 2 (P < 0.001). Nonreticular pigment changes were less frequent in the periphery than in the posterior pole (46% vs. 76%) and negligible in controls.
Peripheral retinal changes are more prevalent in eyes with AMD than in control eyes. Drusen are seen in a majority of eyes with AMD in both the mid and far periphery, whereas pigment changes and features of advanced AMD are less frequent. Age-related macular degeneration may be more than a "macular" condition but one that involves the entire retina. Future longitudinal studies of peripheral changes in AMD and their impact on visual function may contribute to understanding AMD pathogenesis.
比较年龄相关性眼病研究 2 期（AREDS2）中至少患有中度年龄相关性黄斑变性（AMD）的患者与无中度年龄相关性改变（大玻璃膜疣）的对照组患者的周边视网膜变化率。
基于临床患者的横断面评估，同时进行前瞻性研究。
前瞻性研究的参与者。
使用 Optos 200Tx 超广角设备（Optos，邓弗姆林，苏格兰）的 200°假彩色和眼底自发荧光（FAF）图像，以黄斑为中心进行拍摄，然后向上和向下引导。将拼接图像在阅读中心进行分级，并将图像分为 3 个区域（区域 1[后极]、区域 2[中周边]和区域 3[远周边]），以记录周边病变的存在。
周边视网膜病变：玻璃膜疣、色素减退/色素沉着改变、网状假性玻璃膜疣、老年性网状色素变性、鹅卵石样变性和 FAF 异常。
共有 484 名（951 只眼）患有 AMD（病例）的 AREDS2 参与者和 89 名（163 只眼）无 AMD 的对照组患者可进行彩色和 FAF 图像分级。在区域 2 和 3 中，分别有 0.4%至 6%的病例眼出现新生血管和地图状萎缩（GA），而对照组眼的 GA 发生率为 1%。在区域 2 和 3 的上、下 3 个部位，病例眼的玻璃膜疣分别检出率为 97%、78%和 64%，对照组眼的检出率分别为 48%、21%和 9%（所有 P 值均<0.001）。15%的病例眼出现周边网状假性玻璃膜疣。老年性网状色素变性是病例眼中最常见的周边改变，占 48%，对照组眼中占 16%，均出现在区域 2（P<0.001）。与后极相比，周边非网状色素改变的发生率较低（46%对 76%），在对照组中几乎不存在。
与对照组相比，AMD 患者的周边视网膜改变更为常见。在 AMD 患者的中、远周边，大多数患者都有玻璃膜疣，而色素改变和晚期 AMD 的特征则较为少见。年龄相关性黄斑变性可能不仅仅是一种“黄斑”疾病，而是一种累及整个视网膜的疾病。未来对 AMD 周边改变及其对视功能影响的纵向研究，可能有助于了解 AMD 的发病机制。
