School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Centre for Eye Health, University of New South Wales, Sydney, Australia.
Invest Ophthalmol Vis Sci. 2024 Oct 1;65(12):7. doi: 10.1167/iovs.65.12.7.
Outer retinal band integrity strongly predicts late age-related macular degeneration (AMD). However, it is often assessed subjectively as "continuity" using inconsistent definitions. Alternatively, "curvature" of the outer retinal bands is a quantitative metric that strongly correlates with AMD biomarkers and can screen for intermediate AMD. We evaluated the prognostic ability of retinal pigment epithelium (RPE) and ellipsoid zone (EZ) curvature for late AMD against outer retinal band continuity, pigmentary abnormalities, reticular pseudodrusen, and drusen volume.
Consecutive patients with intermediate AMD who progressed to late AMD (n = 17) or remained stable (n = 42) were recruited. RPE and EZ curvature were quantified as a ratio of their lengths over Bruch's membrane using the sinuosity method of assessing river curvature, where a ratio of ∼1 indicates no outer retinal pathology. RPE, EZ, and Bruch's membrane were manually segmented and their lengths automatically extracted. The primary outcomes were outer retinal sinuosity and the odds ratio of predicting late AMD.
Mean follow-up time for progressors and nonprogressors was 4.4 and 3.6 years. RPE sinuosity was strongly associated with pigmentary abnormalities (P = 0.001) and drusen volume (P = 0.004) but not reticular pseudodrusen (P = 0.28). RPE sinuosity >1.03 was the strongest predictor of late AMD developing within 5 years (15 [2.9-75]) and across the study period (25 [2.3-282]). Drusen volume >0.03 mm3 was the strongest predictor of progression within 2 years (33 [2.5-426]), and RPD could not independently predict progression within any time frame.
RPE curvature is a promising, quantitative outer retinal biomarker that can prognosticate late AMD and potentially enhance prognostic models.
外视网膜带的完整性强烈预测晚期年龄相关性黄斑变性（AMD）。然而，它通常是通过使用不一致的定义的“连续性”进行主观评估。或者，外视网膜带的“曲率”是一种与 AMD 生物标志物强烈相关的定量指标，可用于筛查中间型 AMD。我们评估了视网膜色素上皮（RPE）和椭圆体带（EZ）曲率对晚期 AMD 的预测能力，与外视网膜带连续性、色素异常、网状假性色素沉着和脉络膜新生血管体积进行对比。
连续招募了从中度 AMD 进展为晚期 AMD（n=17）或保持稳定（n=42）的患者。RPE 和 EZ 曲率使用评估河流曲率的正弦方法来评估它们的长度与 Bruch 膜的比值，其中比值约为 1 表示没有外视网膜病变。手动分割 RPE、EZ 和 Bruch 膜，并自动提取其长度。主要结局是外视网膜正弦和预测晚期 AMD 的优势比。
进展者和非进展者的平均随访时间分别为 4.4 年和 3.6 年。RPE 正弦与色素异常（P=0.001）和脉络膜新生血管体积（P=0.004）强烈相关，但与网状假性色素沉着（P=0.28）无关。RPE 正弦>1.03 是预测 5 年内（15 [2.9-75]）和整个研究期间（25 [2.3-282]）晚期 AMD 发展的最强预测因子。脉络膜新生血管体积>0.03 mm3 是预测 2 年内进展的最强预测因子（33 [2.5-426]），而 RPD 不能独立预测任何时间框架内的进展。
RPE 曲率是一种有前途的定量外视网膜生物标志物，可预测晚期 AMD，并且可能增强预后模型。
