Huang Antoine, Wu Zhichao, Ansari Georg, Von Der Emde Leon, Pfau Maximilian, Schmitz-Valckenberg Steffen, Fleckenstein Monika, Keenan Tiarnán D L, Sadda Srinivas R, Guymer Robyn H, Cheung Chui Ming Gemmy, Chakravarthy Usha
Singapore National Eye Centre, Singapore; Sorbonne Université, Paris, France.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
Asia Pac J Ophthalmol (Phila). 2025 May-Jun;14(3):100207. doi: 10.1016/j.apjo.2025.100207. Epub 2025 May 19.
This review explores the complex relationship between anatomical alterations and functional consequences in geographic atrophy (GA), the advanced non-neovascular form of age-related macular degeneration. We examine the natural history, progression patterns, structural biomarkers, functional assessments, and structure-function correlations in GA.
Experts contributed specialized knowledge on GA pathophysiology, imaging biomarkers, and functional assessment methods. We synthesized an understanding of the relationship between structural changes (including fundus autofluorescence patterns, optical coherence tomography markers, and novel biomarkers) and functional outcomes (visual acuity, microperimetry, reading performance, and patient-reported outcomes), drawing from authors' research expertise and relevant literature.
While GA is defined by visible areas of outer retinal atrophy, the structure-function relationship is complex and often discordant. Visual acuity incompletely reflects the functional impact of GA, as it may remain preserved until foveal involvement occurs. Microperimetric assessments reveal functional deficits extending beyond visible atrophic borders, with varying degrees of correlation between structural and functional metrics. Different fundus autofluorescence patterns demonstrate distinct functional implications and progression rates. Recent innovations in imaging and visual function testing offer enhanced characterization of disease progression.
The complex relationship between structural and functional measures in GA reflects underlying pathophysiological mechanisms and has important implications for clinical trial endpoints and patient management. Multimodal assessment incorporating both structural and functional parameters is essential for the comprehensive evaluation and management of GA, particularly as novel therapeutic approaches emerge.
本综述探讨地图样萎缩（GA）（年龄相关性黄斑变性的晚期非新生血管形式）中解剖学改变与功能后果之间的复杂关系。我们研究了GA的自然病程、进展模式、结构生物标志物、功能评估以及结构-功能相关性。
专家们贡献了关于GA病理生理学、成像生物标志物和功能评估方法的专业知识。我们综合了对结构变化（包括眼底自发荧光模式、光学相干断层扫描标志物和新型生物标志物）与功能结果（视力、微视野检查、阅读表现和患者报告的结果）之间关系的理解，这些理解来自作者的研究专长和相关文献。
虽然GA由视网膜外层萎缩的可见区域定义，但其结构-功能关系复杂且常常不一致。视力不能完全反映GA的功能影响，因为在黄斑受累之前视力可能保持正常。微视野检查评估显示功能缺陷超出可见萎缩边界，结构和功能指标之间存在不同程度的相关性。不同的眼底自发荧光模式显示出不同的功能意义和进展速度。成像和视觉功能测试方面的最新创新为疾病进展提供了更好的特征描述。
GA中结构与功能测量之间的复杂关系反映了潜在的病理生理机制，对临床试验终点和患者管理具有重要意义。结合结构和功能参数的多模式评估对于GA的全面评估和管理至关重要，特别是在新的治疗方法出现时。
