衰老及年龄相关性黄斑变性中的高传播率与视力：来自ALSTAR2的纵向数据

Hypertransmission and vision in aging and age-related macular degeneration: longitudinal data from ALSTAR2.

作者信息

Johnston Will, Kim Sarah S, Kar Deepayan, Gao Liyan, Clark Mark E, McGwin Gerald, Sloan Kenneth R, Owsley Cynthia, Curcio Christine A, Goerdt Lukas

机构信息

Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL; University of South Alabama, Frederick P. Whiddon College of Medicine, Mobile, AL.

Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.

出版信息

Am J Ophthalmol. 2025 Aug 21. doi: 10.1016/j.ajo.2025.08.038.

DOI:10.1016/j.ajo.2025.08.038

PMID:40849031

Abstract

PURPOSE

To investigate the presence of hypertransmission (HT) in normal aging, early (e)AMD, and intermediate (i)AMD, changes over 3 years, and the impact of HTs ≥ 250 µm (LHyperTD) on seven tests of scotopic, mesopic, and photopic vision.

DESIGN

Prospective cohort study.

SUBJECTS

Participants of the Alabama Study on Early Age-Related Macular Degeneration 2.

METHODS

ALSTAR2 participants underwent spectral domain optical coherence tomography angiography (OCTA), color fundus photography, and vision testing at baseline and 3-year follow-up. HT presence and stepped diameters in choroidal en face slabs were assessed with custom review software. Only LHyperTD were analyzed at follow-up. AMD was staged via AREDS 9-step. Vision at baseline and follow-up between eyes with and without LHyperTD was analyzed with linear regression.

MAIN OUTCOME MEASURES

Presence, size, and illustrative examples of HT, association with tests of photopic, mesopic and scotopic vision.

RESULTS

Baseline data was available on 460 eyes of 460 patients (mean age 71.5 ± 5.7 years, 277 female; 236 normal, 134 eAMD, 90 iAMD). HT of any size were found in iAMD (86.7%), eAMD (35.1%), and normal (3.8%) eyes, with proportional LHyperTD (13.3% vs 4.2% vs 0.4%, p < 0.01). For 339 eyes (mean age 71.2 ± 5.8 years, 206 female, 181 normal, 92 eAMD, 66 iAMD), LHyperTD presence significantly increased in normal (p = 0.01) and iAMD (p < 0.01) but not in eAMD eyes. At baseline, photopic contrast sensitivity (CS), mesopic CS, and rod intercept time (for rod mediated dark adaptation, RMDA) were worse in eyes with LHyperTD compared to eyes without (all p < 0.01). At follow-up, the same were worse in LHyperTD (all p < 0.01), as well as low luminance visual acuity (p < 0.01) and scotopic light sensitivity (p = 0.05).

CONCLUSION

LHyperTD are rare in normal and eAMD eyes and associate with mesopic and scotopic visual functions in addition to risk-indicating RMDA. Delayed RMDA reflects other factors other than LHyperTD including differences in disease stage. Our analysis of HT < 250 µm may inform other studies of early disease. LHyperTD are best utilized as imaging biomarkers for later stages of iAMD than ALSTAR2.

摘要

目的

研究正常衰老、早期（e）年龄相关性黄斑变性（AMD）和中期（i）AMD中是否存在高通透性（HT）、3年内的变化，以及≥250 µm的HT（LHyperTD）对暗视、中间视觉和明视的七项测试的影响。

设计

前瞻性队列研究。

研究对象

阿拉巴马州早期年龄相关性黄斑变性研究2的参与者。

方法

ALSTAR2参与者在基线和3年随访时接受了光谱域光学相干断层扫描血管造影（OCTA）、彩色眼底照相和视力测试。使用定制的复查软件评估脉络膜正面平板中的HT存在情况和阶梯状直径。在随访时仅分析LHyperTD。通过年龄相关性眼病研究（AREDS）9步分期法对AMD进行分期。使用线性回归分析有和没有LHyperTD的眼睛在基线和随访时的视力。

主要观察指标

HT的存在、大小和示例，与明视、中间视觉和暗视测试的相关性。

结果

460例患者的460只眼睛有基线数据（平均年龄71.5±5.7岁，女性277例；正常236例，eAMD 134例，iAMD 90例）。在iAMD（86.7%）、eAMD（35.1%）和正常（3.8%）眼睛中发现了任何大小的HT，LHyperTD比例分别为13.3%、4.2%和0.4%（p<0.01）。对于339只眼睛（平均年龄71.2±5.8岁，女性206例，正常181例，eAMD 92例，iAMD 66例），LHyperTD的存在在正常眼睛（p=0.01）和iAMD眼睛（p<0.01）中显著增加，但在eAMD眼睛中没有增加。在基线时，与没有LHyperTD的眼睛相比，有LHyperTD的眼睛的明视对比敏感度（CS）、中间视觉CS和视杆截距时间（用于视杆介导的暗适应，RMDA）更差（所有p<0.01）。在随访时，LHyperTD眼睛中的上述指标同样更差（所有p<0.01），以及低亮度视力（p<0.01）和暗视光敏感度（p=0.05）。

结论

LHyperTD在正常和eAMD眼睛中很少见，除了指示风险的RMDA外，还与中间视觉和暗视视觉功能相关。延迟的RMDA反映了LHyperTD以外的其他因素，包括疾病阶段的差异。我们对<250 µm的HT的分析可能为其他早期疾病研究提供参考。与ALSTAR2相比，LHyperTD作为iAMD后期阶段的成像生物标志物更有用。