Saeed Abera, Gin Callum, Hodgson Lauren A B, Jannaud Maxime, Hadoux Xavier, Glover Emily K, Gee Erin E, van Wijngaarden Peter, Guymer Robyn H, Wu Zhichao
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Ophthalmol Retina. 2025 May;9(5):412-420. doi: 10.1016/j.oret.2024.12.007. Epub 2024 Dec 11.
To determine local OCT structural correlates of deep visual sensitivity defects (threshold of ≤10 decibels on microperimetry) in early atrophic age-related macular degeneration (AMD).
Prospective observational study.
Forty eyes from 40 participants, with at least incomplete retinal pigment epithelium (RPE) and outer retinal atrophy, or more advanced atrophic lesion(s).
Participants underwent ≥2 targeted, high-density microperimetry tests of atrophic lesions of interest in 1 eye, and high-density 3×3-mm volume scans of that region on a swept-source OCT angiography device, all at a single visit. Seven OCT-defined features of atrophy were manually annotated: hypertransmission, RPE attenuation/disruption, complete RPE loss, ellipsoid zone disruption, external limiting membrane (ELM) disruption, subsidence of the outer plexiform layer and inner nuclear layer, and/or hyporeflective wedge-shaped band, and outer nuclear layer (ONL) thickness.
Association between OCT-defined features of atrophy and presence of a deep visual sensitivity defect at a local, pointwise level.
All OCT-defined features of atrophy were individually associated with the presence of a deep visual sensitivity defect at a pointwise level in univariable mixed-effects logistic regression analyses (P < 0.001 for all). However, only hypertransmission, complete RPE loss, ELM disruption, and ONL thickness remained significantly and independently associated with deep visual sensitivity defects in a multivariable analysis (P ≤ 0.011). A prediction model incorporating these 4 OCT features (partial area under the curve [pAUC] at ≥90% specificity = 0.80) outperformed models using any single feature alone in predicting the presence of deep visual sensitivity defects (pAUC = 0.65 to 0.78, respectively; P ≥ 0.040).
The study identified hypertransmission, complete RPE loss, ELM disruption, and ONL thickness as key OCT-defined features of atrophy independently associated with deep visual sensitivity defects. These findings are important when considering anatomical outcome measures for evaluating interventions for early atrophic AMD that are most likely to capture beneficial treatment effects that will be accompanied by evidence of functional preservation if measured directly.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
确定早期萎缩性年龄相关性黄斑变性（AMD）中深度视觉敏感度缺陷（微视野检查阈值≤10分贝）的局部光学相干断层扫描（OCT）结构相关性。
前瞻性观察性研究。
40名参与者的40只眼睛，至少存在不完全视网膜色素上皮（RPE）和外层视网膜萎缩，或更晚期的萎缩性病变。
参与者在一次就诊时，对一只眼睛中感兴趣的萎缩性病变进行≥2次针对性的高密度微视野检查，并使用扫频源OCT血管造影设备对该区域进行高密度3×3毫米容积扫描。手动标注了7个OCT定义的萎缩特征：高透射率、RPE衰减/中断、RPE完全缺失、椭圆体带中断、外界膜（ELM）中断、外丛状层和内核层下陷和/或低反射楔形带，以及外核层（ONL）厚度。
在局部逐点水平上，OCT定义的萎缩特征与深度视觉敏感度缺陷的存在之间的关联。
在单变量混合效应逻辑回归分析中，所有OCT定义的萎缩特征在逐点水平上均与深度视觉敏感度缺陷的存在单独相关（所有P<0.001）。然而，在多变量分析中，只有高透射率、RPE完全缺失、ELM中断和ONL厚度仍与深度视觉敏感度缺陷显著且独立相关（P≤0.011）。一个纳入这4个OCT特征的预测模型（特异性≥90%时的曲线下部分面积[pAUC]=0.80）在预测深度视觉敏感度缺陷的存在方面优于仅使用任何单个特征的模型（pAUC分别为0.65至0.78；P≥0.040）。
该研究确定高透射率、RPE完全缺失、ELM中断和ONL厚度是与深度视觉敏感度缺陷独立相关的关键OCT定义的萎缩特征。在考虑用于评估早期萎缩性AMD干预措施的解剖学结局指标时，这些发现很重要，这些指标最有可能捕捉到有益的治疗效果，如果直接测量，将伴有功能保留的证据。
在本文末尾的脚注和披露中可能会找到专有或商业披露信息。
