Department of Ophthalmology and Visual Science, Yale School of Medicine, 40 Temple Street, Suite 1B, New Haven, CT, 06510, USA.
Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA.
Graefes Arch Clin Exp Ophthalmol. 2021 Sep;259(9):2643-2651. doi: 10.1007/s00417-021-05145-9. Epub 2021 Mar 19.
To examine the association between geographic atrophy (GA) disease characteristics and mortality risk.
We manually delineated color fundus photographs of 209 Age-Related Eye Disease Study (AREDS) participants with GA secondary to age-related macular degeneration to identify total area of atrophy, GA effective radius growth rate, disease laterality, and the presence of foveal center involvement. Associations between GA characteristics and mortality were assessed with Cox proportional hazards models adjusted for health status indicators.
During a median follow-up of 6.8 years, 48 (23.0%) participants with GA died. In adjusted models, accounting for age, sex, and health status, participants with total GA area in the highest quartile had a significantly increased risk of all-cause mortality compared to those with total GA area in the lowest quartile (hazard ratio [HR], 3.42; 95% confidence interval [CI], 1.32-8.86; P = 0.011). GA effective radius growth rate, bilateral disease, and the presence of foveal center involvement were not significantly associated with mortality. In a multivariable model, including health status indicators and all GA characteristics, total area of atrophy in the highest quartile remained significantly associated with mortality (HR, 4.65; 95% CI, 1.29-16.70; P = 0.019).
More extensive GA, as indicated by a greater total area of atrophy, was associated with an increased risk of all-cause mortality in our cohort. The extent of GA may reflect the extent of underlying disease processes that contribute to greater mortality risk, further suggesting that GA may be part of a systemic rather than purely ocular disease process.
研究地理萎缩（GA）疾病特征与死亡风险之间的关联。
我们对 209 名年龄相关性眼病研究（AREDS）参与者的彩色眼底照片进行了手动描绘，这些参与者患有与年龄相关性黄斑变性相关的 GA，以确定总萎缩面积、GA 有效半径增长率、疾病侧别以及是否存在中央凹受累。使用 Cox 比例风险模型评估 GA 特征与死亡率之间的关联，该模型调整了健康状况指标。
在中位随访 6.8 年期间，48 名（23.0%）患有 GA 的参与者死亡。在调整后的模型中，考虑到年龄、性别和健康状况，总 GA 面积最高四分位数的参与者全因死亡率的风险显著增加，与总 GA 面积最低四分位数的参与者相比（风险比 [HR]，3.42；95%置信区间 [CI]，1.32-8.86；P=0.011）。GA 有效半径增长率、双侧疾病和中央凹受累的存在与死亡率无显著相关性。在包括健康状况指标和所有 GA 特征的多变量模型中，最高四分位数的总萎缩面积与死亡率仍显著相关（HR，4.65；95% CI，1.29-16.70；P=0.019）。
在我们的队列中，更大的 GA 总面积，表明疾病范围更广泛，与全因死亡率风险增加相关。GA 的程度可能反映了导致更高死亡率风险的潜在疾病过程的程度，这进一步表明 GA 可能是全身性疾病过程的一部分，而不仅仅是眼部疾病过程。
