Singapore National Eye Centre, Singapore.
Singapore Eye Research Institute, Singapore.
Br J Ophthalmol. 2023 Sep;107(9):1363-1368. doi: 10.1136/bjophthalmol-2021-321046. Epub 2022 May 9.
To investigate the predictive factors for myopic macular degeneration (MMD) and progression in adults with myopia.
We examined 828 Malay and Indian adults (1579 myopic eyes) with myopia (spherical equivalent (SE) ≤-0.5 dioptres) at baseline who participated in both baseline and 12-year follow-up visits of the Singapore Malay Eye Study and the Singapore Indian Eye Study. Eye examinations, including subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the Meta-Analysis for Pathologic Myopia classification. The predictive factors for MMD development and progression were assessed in adults without and with MMD at baseline, respectively as risk ratios (RR) using multivariable modified Poisson regression models. The receiver operating characteristic curve was used to visualise the performance of the predictive models for the development of MMD, with performance quantified by the area under the curve (AUC).
The 12-year cumulative MMD incidence was 10.3% (95% CI 8.9% to 12.0%) among 1504 myopic eyes without MMD at baseline. Tessellated fundus was a major predictor of MMD (RR=2.50, p<0.001), among other factors including age, worse SE and longer AL (all p<0.001). The AUC for prediction of MMD development was found to be 0.78 (95% CI 0.76 to 0.80) for tessellated fundus and increased significantly to an AUC of 0.86 (95% CI 0.84 to 0.88) with the combination of tessellated fundus with age, race, gender and SE (p<0.001). Older age (p=0.02), worse SE (p<0.001) and longer AL (p<0.001) were found to be predictors of MMD progression.
In adults with myopia without MMD, tessellated fundus, age, SE and AL had good predictive value for incident MMD. In adults with MMD, 1 in 10 eyes experienced progression over the same period. Older age, more severe myopia and longer AL were independent risk factors for progression.
探讨近视性黄斑变性（MMD）和进展的预测因素。
我们检查了基线时参与新加坡马来眼研究和新加坡印度眼研究的 828 名马来和印度成年人（1579 只近视眼）的近视（等效球镜（SE）≤-0.5 屈光度）。进行了眼部检查，包括主观验光和眼轴（AL）测量。根据病理性近视分类的 Meta 分析对眼底照片进行 MMD 分级。分别在基线时无 MMD 和有 MMD 的成年人中，使用多变量修正泊松回归模型评估 MMD 发生和进展的预测因素。使用受试者工作特征曲线来可视化 MMD 发生的预测模型的性能，通过曲线下面积（AUC）来量化性能。
在基线时无 MMD 的 1504 只近视眼中，12 年累积 MMD 发生率为 10.3%（95%CI 8.9%至 12.0%）。棋盘格状眼底是 MMD 的主要预测因素（RR=2.50，p<0.001），其他因素包括年龄、更差的 SE 和更长的 AL（均 p<0.001）。发现棋盘格状眼底预测 MMD 发生的 AUC 为 0.78（95%CI 0.76 至 0.80），而棋盘格状眼底与年龄、种族、性别和 SE 相结合时 AUC 显著增加至 0.86（95%CI 0.84 至 0.88）（p<0.001）。年龄较大（p=0.02）、SE 更差（p<0.001）和 AL 更长（p<0.001）是 MMD 进展的预测因素。
在无 MMD 的近视成年人中，棋盘格状眼底、年龄、SE 和 AL 对新发 MMD 具有良好的预测价值。在患有 MMD 的成年人中，在同一时期每 10 只眼中就有 1 只发生进展。年龄较大、近视程度更严重和 AL 更长是进展的独立危险因素。
