Futterknecht Stefan, Anders Philipp, Mai Julia, Riedl Sophie, Hall Ursula, Gabrani Chrysoula, Pfau Kristina, Menten Martin J, Rueckert Daniel, Prevost A Toby, Bogunovic Hrvoje, Fritsche Lars G, Schmidt-Erfurth Ursula, Sivaprasad Sobha, Lotery Andrew, Scholl Hendrik P N, Pfau Maximilian
Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland.
Invest Ophthalmol Vis Sci. 2025 Feb 3;66(2):6. doi: 10.1167/iovs.66.2.6.
The purpose of this study was to evaluate the feasibility and utility of optical coherence tomography (OCT)-based, targeted microperimetry grids in assessing focal lesions in intermediate age-related macular degeneration (iAMD).
The multicenter, prospective PINNACLE study enrolled 395 patients with iAMD aged 55 to 90 years across 12 international sites. Participants underwent imaging, including OCT and microperimetry, every 4 to 12 months over 3 years. Deep learning algorithms detected focal lesions and changes in OCT images, including drusen regression, EZ/IZ loss with hypertransmission, and subretinal fluid, guiding 5-point microperimetry targeted to lesion locations. Data were analyzed using linear mixed models to estimate differences between retinal sensitivity measured by the 5-point focal grids and sensitivity interpolated from the 24-point standard grids.
The final analysis included 93 eyes from 83 patients, assessing 605 of the 5-point targeted grids and standard grids across 235 focal lesions. The Pearson correlation between focally measured sensitivity and interpolated sensitivity was 0.76. However, interpolation from the standard grid could be erroneous, especially in central regions of lesions characterized by EZ/IZ loss with hypertransmission and subretinal fluid. Interpolation errors increased with distance to the nearest measurement point (slope = 2.20 dB per degree, 95% confidence interval [CI] = 1.52 to 2.87). A significant negative relationship was found between interpolation errors and retinal sensitivity, with the highest errors in areas of low sensitivity. Lesion size significantly impacted interpolation errors for EZ/IZ loss with hypertransmission (slope = -19.41 dB/mm², 95% CI = -29.63 to -9.18).
Targeted grids improved the detection and understanding of how focal retinal changes affect visual function in patients with iAMD, supporting the development of therapeutic interventions.
本研究旨在评估基于光学相干断层扫描（OCT）的靶向微视野计网格在评估中度年龄相关性黄斑变性（iAMD）中的局灶性病变时的可行性和实用性。
多中心前瞻性PINNACLE研究在12个国际地点招募了395例年龄在55至90岁之间的iAMD患者。参与者在3年中每4至12个月接受一次成像检查，包括OCT和微视野计检查。深度学习算法检测OCT图像中的局灶性病变和变化，包括玻璃膜疣消退、伴有高透过率的EZ/IZ丧失以及视网膜下液，指导针对病变位置的5点微视野计检查。使用线性混合模型分析数据，以估计由5点局灶性网格测量的视网膜敏感度与从24点标准网格插值得到的敏感度之间的差异。
最终分析纳入了来自83例患者的93只眼，评估了235个局灶性病变中的605个5点靶向网格和标准网格。局灶性测量的敏感度与插值敏感度之间的Pearson相关性为0.76。然而，从标准网格插值可能会出现错误，特别是在以伴有高透过率的EZ/IZ丧失和视网膜下液为特征的病变中心区域。插值误差随着与最近测量点的距离增加而增大（斜率 = 每度2.20 dB，95%置信区间[CI] = 1.52至2.87）。在插值误差与视网膜敏感度之间发现了显著负相关，在低敏感度区域误差最高。病变大小对伴有高透过率的EZ/IZ丧失的插值误差有显著影响（斜率 = -19.41 dB/mm²，95% CI = -29.63至 -9.18）。
靶向网格改善了对iAMD患者局灶性视网膜变化如何影响视觉功能的检测和理解，支持了治疗干预措施的开发。
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