Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Doheny Eye Institute, Los Angeles, California, United States.
Invest Ophthalmol Vis Sci. 2023 Sep 1;64(12):41. doi: 10.1167/iovs.64.12.41.
Progress toward treatment and prevention of age-related macular degeneration (AMD) requires imaging end points that relate to vision. We investigated choriocapillaris flow signal deficits (FD%) and visual function in eyes of individuals aged ≥60 years, with and without AMD.
One eye of each participant in the baseline visit of the Alabama Study on Early Age-Related Macular Degeneration 2 (ALSTAR2; NCT04112667) was studied. AMD presence and severity was determined using the Age-Related Eye Disease Study (AREDS) grading system. FD% was quantified using macular spectral domain optical coherence tomography angiography (OCTA) scans. Vision tests included rod-mediated dark adaptation (RMDA), best-corrected visual acuity, and contrast sensitivity (photopic and mesopic), and microperimetric light sensitivity (scotopic, mesopic, and photopic). Presence of subretinal drusenoid deposits (SDD) was determined using multimodal imaging.
In 410 study eyes of 410 participants (mean [SD] age = 71.7 years [5.9]), FD% was higher in early AMD (mean [SD] = 54.0% [5.5], N = 122) and intermediate AMD (59.8% [7.4], N = 92), compared to normal (52.1% [5.3], N = 196) eyes. Among visual functions evaluated, RMDA showed the strongest association with FD% (r = 0.35, P < 0.0001), followed by contrast sensitivity (r = -0.22, P < 0.0001). Eyes with SDD had worse FD% (58.3% [7.4], N = 87), compared to eyes without SDD (53.4% [6.0], N = 323, P = < 0.0001).
Choriocapillaris FD% were associated with AMD severity and with impaired vision, especially RMDA. Reduced metabolic transport and exchange across the choriocapillaris-Bruch's membrane retinal pigment epithelium (RPE) complex, a causal factor for high-risk soft drusen formation, also may impair photoreceptor sustenance from the circulation. This includes retinoid resupply, essential to dynamic rod function.
为了推进与年龄相关性黄斑变性（AMD）相关的治疗和预防研究，我们需要找到与视力相关的成像终点。本研究旨在探讨伴有或不伴有 AMD 的≥60 岁个体脉络膜毛细血管血流信号缺失（FD％）与视觉功能的关系。
纳入 ALSTAR2 研究基线检查中每只眼（NCT04112667）的一只眼。采用年龄相关性眼病研究（AREDS）分级系统确定 AMD 的存在和严重程度。采用黄斑区谱域光学相干断层扫描血管造影（OCTA）扫描定量 FD％。视力检查包括杆状细胞介导的暗适应（RMDA）、最佳矫正视力和对比敏感度（明适应和中适应）以及微视野光敏感度（暗适应、中适应和明适应）。采用多模态成像确定是否存在视网膜下类脂沉积（SDD）。
在 410 名参与者的 410 只眼中（平均[标准差]年龄=71.7 岁[5.9]），早期 AMD（平均[标准差]=54.0%[5.5]，N=122）和中间 AMD（59.8%[7.4]，N=92）的 FD％高于正常眼（52.1%[5.3]，N=196）。在评估的各种视觉功能中，RMDA 与 FD％相关性最强（r=0.35，P<0.0001），其次是对比敏感度（r=-0.22，P<0.0001）。与无 SDD 的眼（53.4%[6.0]，N=323，P<0.0001）相比，有 SDD 的眼 FD％更差（58.3%[7.4]，N=87）。
脉络膜毛细血管 FD％与 AMD 严重程度和视力下降相关，尤其是 RMDA。脉络膜毛细血管-布鲁赫膜视网膜色素上皮（RPE）复合体的代谢转运和交换减少，是高危软性玻璃膜疣形成的一个因果因素，也可能损害感光细胞从循环中获得的营养物质。这包括视黄醇的再供应，这对动态杆状细胞功能至关重要。
