Wu Zhichao, Blodi Barbara A, Holz Frank G, Jaffe Glenn J, Liakopoulos Sandra, Sadda Srinivas R, Schmitz-Valckenberg Steffen, Bonse Mari, Brown Tyler, Choong John, Clifton Bailey, Corradetti Giulia, Hodgson Lauren A B, Lentzsch Anna M, Mahmoudi Alireza, Pak Jeong W, Saßmannshausen Marlene, Skalak Cindy, von der Emde Leon, Winkler Jordan, Guymer Robyn H
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia.
Ophthalmol Sci. 2025 Jul 16;5(6):100884. doi: 10.1016/j.xops.2025.100884. eCollection 2025 Nov-Dec.
To identify combination(s) of OCT changes that define atrophic age-related macular degeneration (AMD) lesions associated with repeatable deep visual sensitivity defects.
Reader study.
One hundred seventy-one OCT scans from 60 eyes of 53 participants.
Participants underwent 2 high-density targeted microperimetry tests (Macular Integrity Assessment device with Goldmann Size III stimuli) per visit of a 3.5° (approximately 1000 μm) diameter region-of-interest that had evidence of at least incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA). OCT B-scans within the region sampled on microperimetry were annotated by 12 readers from 6 established reading centers for 7 different features related to RPE and outer retinal atrophy. The prevalence of the presence of a repeatable ≤10 decibel (dB) defect on microperimetry for lesions categorized by 18 different combinations of such features, or criteria, was determined.
The criteria for OCT-defined atrophic changes showing a ≥90% prevalence of a repeatable ≤10 dB defect, which has previously shown to be characteristic of regions with a truly nonresponding test location on microperimetry.
Sixty percent of complete RPE and outer retinal atrophy (cRORA) lesions-based on the presence of hypertransmission and RPE abnormalities ≥250 μm in width, with evidence of overlying photoreceptor (PR) degeneration, on an OCT B-scan-had a repeatable ≤10 dB defect. However, between 92% and 98% of lesions with both hypertransmission and complete RPE loss ≥500 μm, and with evidence of any size of any feature of overlying PR degeneration, had a repeatable ≤10 dB defect, depending on the criteria considered. Between 92% and 95% of lesions with hypertransmission ≥500 μm and either overlying external limiting membrane disruption, or outer plexiform layer and inner nuclear layer subsidence, and/or hyporeflective wedge-shaped band(s) ≥500 μm, with or without RPE abnormalities, had a repeatable ≤10 dB defect.
This study identified various criteria for OCT-defined atrophic AMD lesions with functional characteristics that can be expected of regions with a truly nonresponding test location on high-density targeted microperimetry testing (i.e., having a ≥90% prevalence of a repeatable ≤10 dB defect). Such OCT-defined lesions could thus serve as functionally relevant clinical endpoints of end-stage atrophic AMD to facilitate preventative treatment trials.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
确定可定义与可重复性深度视觉敏感度缺陷相关的萎缩性年龄相关性黄斑变性（AMD）病变的光学相干断层扫描（OCT）变化组合。
读者研究。
来自53名参与者60只眼睛的171次OCT扫描。
参与者每次就诊时对直径3.5°（约1000μm）的感兴趣区域进行2次高密度靶向微视野测试（使用戈德曼III号刺激的黄斑完整性评估设备），该区域有至少不完全视网膜色素上皮（RPE）和外层视网膜萎缩（iRORA）的证据。微视野检查所采样区域内的OCT B扫描由来自6个既定阅读中心的12名读者针对与RPE和外层视网膜萎缩相关的7种不同特征进行标注。确定了由18种不同此类特征组合或标准分类的病变在微视野检查中出现可重复性≤10分贝（dB）缺陷的患病率。
OCT定义的萎缩性变化标准，显示可重复性≤10 dB缺陷的患病率≥90%，此前已证明这是微视野检查中真正无反应测试位置区域的特征。
基于OCT B扫描上存在高透射率和宽度≥250μm的RPE异常，且有上方光感受器（PR）变性证据的完全RPE和外层视网膜萎缩（cRORA）病变中，60%有可重复性≤10 dB缺陷。然而，根据所考虑的标准，在同时存在高透射率和完全RPE缺失≥500μm，且有任何大小的上方PR变性任何特征证据的病变中，92%至98%有可重复性≤10 dB缺陷。在高透射率≥500μm且有上方外界膜破坏，或外丛状层和内核层下沉，和/或低反射楔形带≥500μm，无论有无RPE异常的病变中，92%至95%有可重复性≤10 dB缺陷。
本研究确定了OCT定义的萎缩性AMD病变的各种标准，其功能特征与高密度靶向微视野测试中真正无反应测试位置的区域预期特征相符（即可重复性≤10 dB缺陷的患病率≥90%）。因此，此类OCT定义的病变可作为终末期萎缩性AMD功能相关的临床终点，以促进预防性治疗试验。
专有或商业披露信息可在本文末尾的脚注和披露中找到。
