Grewal Manjot Kaur, Chandra Shruti, Gurudas Sarega, Rasheed Rajna, Sen Piyali, Menon Deepthy, Bird Alan, Jeffery Glen, Sivaprasad Sobha
Institute of Ophthalmology, University College London, London, UK.
NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK.
Eye (Lond). 2022 Feb;36(2):398-406. doi: 10.1038/s41433-021-01488-z. Epub 2021 Mar 9.
To evaluate functional clinical endpoints and their structural correlations in AMD, with a focus on subretinal drusenoid deposits (SDD).
This prospective study enroled 50 participants (11 controls, 17 intermediate AMD (iAMD) with no SDD, 11 iAMD with SDD and 11 non-foveal atrophic AMD). Participants underwent best-corrected visual acuity (BCVA), low luminance visual acuity (LLVA), low luminance questionnaire (LLQ), scotopic thresholds, rod-intercept time (RIT), photopic flicker electroretinograms and multimodal imaging. Functional and structural relationships were assessed.
Compared with healthy participants, BCVA, LLVA, scotopic thresholds were depressed, and RIT prolonged in iAMD patients with SDD (p = 0.028, p = 0.045, p = 0.014 and p < 0.0001 respectively). Patients with SDD also had reduced scotopic function and delayed RIT compared to iAMD without SDD (p = 0.005 and p < 0.0001). Eyes with SDD and non-foveal atrophy did not differ functionally. Nor did healthy subjects compared with iAMD without SDD. Functional parameters were significantly associated with scotopic thresholds (r = 0.39-0.64). BCVA, LLVA and scotopic thresholds correlated well with ONL volume, ONL thickness and choroidal thickness (r = 0.34-0.61).
Eyes with SDD are surrogate markers of photoreceptor abnormalities comparable with non-central atrophy and should be sub-analysed in clinical trials evaluating potential prophylactic agents to decrease the progression of AMD and may even require different therapeutic interventions.
评估年龄相关性黄斑变性（AMD）的功能性临床终点及其结构相关性，重点关注视网膜下类玻璃膜疣沉积物（SDD）。
这项前瞻性研究招募了50名参与者（11名对照者、17名无SDD的中度AMD（iAMD）患者、11名有SDD的iAMD患者和11名非黄斑中心凹萎缩性AMD患者）。参与者接受了最佳矫正视力（BCVA）、低亮度视力（LLVA）、低亮度问卷（LLQ）、暗视阈值、视杆细胞截距时间（RIT）、明视闪烁视网膜电图和多模态成像检查。评估了功能和结构关系。
与健康参与者相比，有SDD的iAMD患者的BCVA、LLVA、暗视阈值降低，RIT延长（分别为p = 0.028、p = 0.045、p = 0.014和p < 0.0001）。与无SDD的iAMD患者相比，有SDD的患者暗视功能也降低，RIT延迟（p = 0.005和p < 0.0001）。有SDD和非黄斑中心凹萎缩的眼睛在功能上没有差异。健康受试者与无SDD的iAMD患者相比也没有差异。功能参数与暗视阈值显著相关（r = 0.39 - 0.64）。BCVA、LLVA和暗视阈值与外核层（ONL）体积、ONL厚度和脉络膜厚度相关性良好（r = 0.34 - 0.61）。
有SDD的眼睛是与非中心萎缩相当的光感受器异常的替代标志物，在评估潜在预防药物以降低AMD进展的临床试验中应进行亚组分析，甚至可能需要不同的治疗干预措施。
