Saßmannshausen Marlene, Ameln Julius, von der Emde Leon, Holz Frank G, Ach Thomas, Harmening Wolf M
Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
J Clin Med. 2024 Dec 20;13(24):7785. doi: 10.3390/jcm13247785.
: Lesions characterized as complete retinal pigment epithelium and outer retinal atrophy (cRORA) are linked to the progression of intermediate age-related macular degeneration (iAMD). However, the extent of functional impairment of such precursor lesions remains uncertain. : In this cross-sectional study, 4 participants (mean age ± standard deviation: 71.5 ± 2.1 years) underwent extensive multimodal imaging and psychophysical testing of cRORA lesions secondary to iAMD. Lesion-specific functional testing was performed using patient individualized testing grids with clinical conventional available (Stimulus size: 0.43°, ~125 µm) and experimental adaptive optics scanning light ophthalmoscope (AOSLO, stimulus size 0.07°, ~20 µm) based microperimetry (MP). One cRORA lesion site and one in-eye control region were tested per patient, respectively. : AOSLO imaging revealed an overall decrease in photoreceptor reflectivity, areas of hyporeflectivity over drusen, interspersed with hyperreflective foci, and disrupted photoreceptor mosaic in regions of cRORA. Localized retinal sensitivity assessment with clinical conventional MP yielded an average loss of -14.0 ± 3.3 dB at cRORA lesions compared to the in-eye control regions. In contrast, localized visual impairment assessed by high-resolution AOSLO-MP with smaller test stimuli (20 µm) revealed a sensitivity loss of -15.1 ± 5.1 dB at cRORA lesions ( < 0.01). Notably, also the area surrounding cRORA lesions can be impacted. : We demonstrated that cRORA lesions are associated with severe localized functional impairment. cRORA precursor lesions may thus be considered as a surrogate outcome measure in future interventional iAMD trials.
特征为完全视网膜色素上皮和外层视网膜萎缩（cRORA）的病变与中度年龄相关性黄斑变性（iAMD）的进展相关。然而，这类前驱病变的功能损害程度仍不确定。
在这项横断面研究中，4名参与者（平均年龄±标准差：71.5±2.1岁）接受了针对iAMD继发的cRORA病变的广泛多模态成像和心理物理学测试。使用患者个体化测试网格，通过临床常规可用的（刺激大小：0.43°，约125μm）和基于实验性自适应光学扫描激光检眼镜（AOSLO，刺激大小0.07°，约20μm）的微视野计（MP）进行病变特异性功能测试。每位患者分别测试一个cRORA病变部位和一个眼内对照区域。
AOSLO成像显示，cRORA区域的光感受器反射率总体下降，在玻璃膜疣上有低反射区域，其间散布着高反射灶，且光感受器镶嵌结构遭到破坏。与眼内对照区域相比，临床常规MP对视网膜局部敏感性的评估显示，cRORA病变处平均损失-14.0±3.3dB。相比之下，使用较小测试刺激（20μm）的高分辨率AOSLO-MP评估的局部视力损害显示，cRORA病变处敏感性损失为-15.1±5.1dB（P<0.01）。值得注意的是，cRORA病变周围区域也可能受到影响。
我们证明，cRORA病变与严重的局部功能损害相关。因此，cRORA前驱病变可被视为未来iAMD干预试验中的替代结局指标。
