Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut.
Ophthalmol Retina. 2021 Aug;5(8):761-774. doi: 10.1016/j.oret.2020.11.003. Epub 2020 Nov 17.
To investigate the topographic distribution of geographic atrophy (GA) and to identify an anatomic endpoint that correlates with visual acuity (VA) in eyes with GA.
Retrospective analysis of a multicenter, prospective, randomized controlled trial.
The Age-Related Eye Disease Study participants with GA secondary to nonexudative age-related macular degeneration.
We manually delineated GA on 1654 fundus photographs of 365 eyes. We measured GA areas in 9 subfields on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid and correlated them with VA via a mixed-effects model. We determined the optimal diameter for the central zone by varying the diameter from 0 to 10 mm until the highest r between GA area in the central zone and VA was achieved. We estimated the VA decline rate over 8 years using a linear mixed model.
Geographic atrophy area in macular subfields and VA.
The percentage of area affected by GA declined as a function of retinal eccentricity. GA area was higher in the temporal than the nasal region (1.30 ± 1.75 mm vs. 1.10 ± 1.62 mm; P = 0.005) and in the superior than the inferior region (1.26 ± 1.73 mm vs. 1.03 ± 1.53 mm; P < 0.001). Total GA area correlated poorly with VA (r = 0.07). Among GA areas in 9 subfields, only GA area in the central zone was associated independently with VA (P < 0.001). We determined 1 mm as the optimal diameter for the central zone in which GA area correlated best with VA (r = 0.45). On average, full GA coverage of the central 1-mm diameter zone corresponded to 34.8 letters' decline in VA. The VA decline rate was comparable between eyes with initial noncentral and central GA before GA covered the entire central 1-mm diameter zone (2.7 letters/year vs. 2.8 letters/year; P = 0.94).
The prevalence of GA varies significantly across different macular regions. Although total GA area was associated poorly with VA, GA area in the central 1-mm diameter zone was correlated significantly with VA and may serve as a surrogate endpoint in clinical trials.
研究地图样萎缩（GA）的地形分布，并确定与 GA 眼视力（VA）相关的解剖终点。
多中心、前瞻性、随机对照试验的回顾性分析。
与非渗出性年龄相关性黄斑变性相关的 GA 继发于年龄相关性眼病研究的参与者。
我们在 365 只眼睛的 1654 张眼底照片上手动描绘 GA。我们在 ETDRS 网格的 9 个亚区测量 GA 面积，并通过混合效应模型将其与 VA 相关联。我们通过改变直径从 0 到 10 毫米，直到中央区域 GA 面积与 VA 之间的 r 值最高，确定中央区域的最佳直径。我们使用线性混合模型估计 8 年内的 VA 下降率。
黄斑亚区 GA 面积和 VA。
受 GA 影响的区域百分比随视网膜偏心度的变化而降低。颞侧 GA 面积高于鼻侧（1.30±1.75mm 比 1.10±1.62mm；P=0.005），上方 GA 面积高于下方（1.26±1.73mm 比 1.03±1.53mm；P<0.001）。总 GA 面积与 VA 相关性差（r=0.07）。在 9 个亚区的 GA 面积中，只有中央区的 GA 面积与 VA 独立相关（P<0.001）。我们确定 1mm 为中央区的最佳直径，其中 GA 面积与 VA 的相关性最佳（r=0.45）。平均而言，中央 1mm 直径区完全覆盖 GA 对应于 VA 下降 34.8 个字母。在 GA 覆盖整个中央 1mm 直径区之前，初始非中央和中央 GA 眼的 VA 下降率相当（每年 2.7 个字母与每年 2.8 个字母；P=0.94）。
GA 在不同的黄斑区域之间差异显著。尽管总 GA 面积与 VA 相关性差，但中央 1mm 直径区的 GA 面积与 VA 显著相关，可能成为临床试验中的替代终点。
