Lei Jianqin, Balasubramanian Siva, Abdelfattah Nizar Saleh, Nittala Muneeswar G, Sadda SriniVas R
Doheny Image Reading Center, Doheny Eye Institute, 1350 San Pablo St., DVRC211, Los Angeles, CA, 90033, USA.
Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Graefes Arch Clin Exp Ophthalmol. 2017 Aug;255(8):1551-1558. doi: 10.1007/s00417-017-3693-y. Epub 2017 May 22.
To develop a simple, clinically practical, optical coherence tomography (OCT)-based scoring system for early age-related macular degeneration (AMD) to prognosticate risk for progression to late AMD.
We retrospectively reviewed OCT images (512 × 128 macular cube, Cirrus) from 138 patients diagnosed of early AMD in at least one eye and follow-up of at least 12 months. For patients with early AMD in both eyes, only the right eye was chosen as the study eye for longitudinal assessment. Scans were graded on four SD-OCT criteria associated with disease progression in previous studies: drusen volume within a central 3-mm circle ≥0.03 mm, intraretinal hyperreflective foci (HRF), hyporeflective foci (hRF) within a drusenoid lesion (DL), and subretinal drusenoid deposits (SDD). Each criterion was assigned one point. For risk assessment of the study eye, the baseline status of the fellow eye was also considered, and thus these four features were also assessed in the fellow eye. The number of risk factors were summed for both eyes, yielding a total score (TS) of 0 to 8 for each patient. A fellow eye with evident choroidal neovascularization (CNV) or atrophy automatically received 4 points. Scores were then grouped into four categories to facilitate comparative analysis: I. (TS of 0, 1, 2), II. (TS of 3, 4), III. (TS of 5, 6) and IV. (TS of 7, 8). Correlation of baseline category assignment with progression to late AMD (defined as the presence of atrophy or CNV on OCT) by the last follow-up visit was evaluated with logistic regression analysis.
The rate of progression to late AMD was 39.9% (55/138). Progression rates by category (I to IV) were 0, 14.3, 47.5, and 73.3%, respectively. Logistic regression analysis showed risk of progression to late AMD was 3.0 times (95% CI: 1.2-7.9) higher for an eye assigned to category IV than for an eye in category III and 16.4 (95% CI: 4.7-58.8) times higher than for an eye in category II.
A simple scoring system relevant to prognosis for early AMD, and practical for use in a busy clinic, can be developed using SD-OCT criteria alone.
开发一种基于光学相干断层扫描（OCT）的简单、临床实用的评分系统，用于早期年龄相关性黄斑变性（AMD），以预测进展为晚期AMD的风险。
我们回顾性分析了138例至少一只眼睛被诊断为早期AMD且随访至少12个月的患者的OCT图像（512×128黄斑立方体，Cirrus）。对于双眼均为早期AMD的患者，仅选择右眼作为纵向评估的研究眼。根据先前研究中与疾病进展相关的四个SD-OCT标准对扫描进行分级：中心3毫米圆圈内的玻璃膜疣体积≥0.03立方毫米、视网膜内高反射灶（HRF）、玻璃膜疣样病变（DL）内的低反射灶（hRF）以及视网膜下玻璃膜疣样沉积物（SDD）。每个标准赋予1分。为了评估研究眼的风险，还考虑了对侧眼的基线状态，因此也对其进行这四个特征的评估。将双眼的风险因素数量相加，得出每位患者的总分（TS）为0至8分。对侧眼有明显脉络膜新生血管（CNV）或萎缩的自动得4分。然后将分数分为四类以方便比较分析：I.（TS为0、1、2），II.（TS为3、4），III.（TS为5、6）和IV.（TS为7、8）。通过逻辑回归分析评估基线类别分配与最后一次随访时进展为晚期AMD（定义为OCT上存在萎缩或CNV）之间的相关性。
进展为晚期AMD的发生率为39.9%（55/138）。按类别（I至IV）的进展率分别为0、14.3%、47.5%和73.3%。逻辑回归分析显示，IV类眼中进展为晚期AMD的风险是III类眼的3.0倍（95%CI：1.2 - 7.9），是II类眼的16.4倍（95%CI：4.7 - 58.8）。
仅使用SD-OCT标准就可以开发出一种与早期AMD预后相关且适用于繁忙诊所的简单评分系统。
