Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Br J Ophthalmol. 2024 Jan 29;108(2):263-267. doi: 10.1136/bjo-2022-322676.
BACKGROUND/AIMS: To investigate the additional prognostic value of quantifying the extent of colour fundus photography (CFP)-defined hyperpigmentary abnormalities (HPAs) compared with their presence alone for predicting progression to late-stage age-related macular degeneration (AMD) and to understand their association with visual sensitivity in individuals with intermediate AMD.
140 participants with bilateral large drusen underwent multimodal imaging and microperimetry at baseline and then every 6 months for up to 3 years. Baseline CFPs were graded for the presence of HPAs and their extent was quantified. Optical coherence tomography (OCT) scans were used to quantify drusen volume. Predictive models for progression to late AMD (including OCT signs of atrophy) were developed using either HPA presence or extent. The association between HPA extent with mean visual sensitivity (both overall and sector based) was also evaluated. All models were adjusted for the confounders of baseline age and drusen volume.
The predictive performance for late AMD development was not significantly different for HPA presence or extent (p=0.92). Increasing HPA extent in each sector, but not its overall extent in an eye, was associated with reduced sector-based visual sensitivity (p<0.001 and p=0.671, respectively).
In a cohort with bilateral large drusen, quantifying HPA extent did not improve the prediction of late AMD development compared with presence alone. HPA extent was associated with more local, rather than generalised, reductions in visual sensitivity. These findings suggest that quantification of HPA extent adds little to the prediction of AMD progression, but that it provides an imaging biomarker of visual dysfunction.
背景/目的：探究相较于单纯评估色素异常（HPAs）的存在，量化彩照眼底摄影（CFP）定义的 HPAs 的范围对于预测晚期年龄相关性黄斑变性（AMD）进展的额外预后价值，并理解其与中间型 AMD 患者的视觉敏感性之间的关联。
140 名双侧大玻璃膜疣患者在基线时接受了多模态成像和微视野检查，然后每 6 个月进行一次检查，持续 3 年。基线 CFP 评估 HPAs 的存在及其范围。使用光学相干断层扫描（OCT）扫描来量化玻璃膜疣体积。使用 HPAs 的存在或范围来开发预测晚期 AMD（包括 OCT 萎缩迹象）进展的模型。还评估了 HPAs 范围与平均视觉敏感性（整体和基于扇区）之间的关联。所有模型均根据基线年龄和玻璃膜疣体积的混杂因素进行调整。
HPAs 的存在或范围对于晚期 AMD 发展的预测性能没有显著差异（p=0.92）。每个扇区的 HPAs 范围增加，但不是眼睛的整体范围增加，与基于扇区的视觉敏感性降低相关（p<0.001 和 p=0.671）。
在双侧大玻璃膜疣的队列中，与单纯存在相比，量化 HPAs 范围并没有改善晚期 AMD 发展的预测。HPAs 范围与更局部而非整体的视觉敏感性降低相关。这些发现表明，量化 HPAs 范围对于 AMD 进展的预测作用不大，但它提供了视觉功能障碍的影像学生物标志物。
