Bressler N M, Munoz B, Maguire M G, Vitale S E, Schein O D, Taylor H R, West S K
Retinal Vascular Center, Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Md.
Arch Ophthalmol. 1995 Mar;113(3):301-8. doi: 10.1001/archopht.1995.01100030055022.
To obtain 5-year longitudinal data on age-related macular degeneration (AMD) that might be useful for disease prognosis, public health planning, and clinical trial development.
Baseline (1985) and 5-year follow-up (1990) fundus photographs of 483 watermen over 30 years of age who participated in a cohort study conducted on the eastern shore of Maryland were graded independently in a reliable, standardized fashion. Eyes in which AMD appeared or disappeared also were graded in a side-by-side fashion.
Development of definite choroidal neovascularization and/or disciform scarring occurred in one of 50 participants over 70 years of age, specifically one of 15 participants over 70 years of age with AMD-3 (defined as large or confluent drusen focal hyperpigmentation of the retinal pigment epithelium [RPE], and/or nongeographic atrophy of the RPE). Appearance of large drusen, focal hyperpigmentation, or AMD-3 was age related, occurring in 5%, 1%, and 7%, respectively, of participants aged 50 to 59 years; 17%, 3%, and 14%, respectively, of participants aged 60 to 69 years; and 17%, 9%, and 26%, respectively, of participants aged 70 years or more. Disappearance of large drusen, hyperpigmentation, or AMD-3 occurred in 16 (34%) of 47 participants, 11 (58%) of 19 participants, and 17 (28%) of 61 participants, respectively, who had each feature photographically present in 1985. Among the 47 eyes identified in which AMD-3 developed by independent gradings, 38 cases of AMD-3 (81%) were confirmed on side-by-side grading. Among the 16 eyes identified as having AMD-3 that disappeared, nine disappearances (56%) were confirmed. Borderline differences in appearance of pigment, drusen size, drusen location, or photographic quality may have accounted for disappearance in seven cases (44%).
Prospective studies on the nonneovascular features of AMD (including large drusen and abnormalities of the RPE) must account for the appearance and disappearance of these features and support the idea that side-by-side gradings can complement independent gradings identifying appearance or disappearance of features of AMD.
获取与年龄相关性黄斑变性（AMD）相关的5年纵向数据，这些数据可能对疾病预后、公共卫生规划及临床试验发展有用。
对参与在马里兰州东海岸进行的一项队列研究的483名30岁以上渔民的基线（1985年）和5年随访（1990年）眼底照片，以可靠、标准化的方式进行独立分级。出现或消失AMD的眼睛也进行并排分级。
在50名70岁以上参与者中，有1人出现明确的脉络膜新生血管形成和/或盘状瘢痕，具体而言，在15名70岁以上患有AMD-3（定义为大的或融合的玻璃膜疣、视网膜色素上皮[RPE]局灶性色素沉着和/或RPE非地图样萎缩）的参与者中，有1人出现上述情况。大玻璃膜疣、局灶性色素沉着或AMD-3的出现与年龄相关，在50至59岁的参与者中分别为5%、1%和7%；在60至69岁的参与者中分别为17%、3%和14%；在70岁及以上的参与者中分别为17%、9%和26%。大玻璃膜疣、色素沉着或AMD-3消失的情况分别出现在47名参与者中的16名（34%）、19名参与者中的11名（58%）以及61名参与者中的17名（28%），这些参与者在1985年时各自的特征在照片上均有显示。在经独立分级确定出现AMD-3的47只眼中，并排分级确认了38例AMD-3（81%）。在确定为AMD-3已消失的16只眼中，确认了9例消失（56%）。色素外观、玻璃膜疣大小、玻璃膜疣位置或照片质量的边界差异可能是7例（44%）消失情况的原因。
关于AMD非新生血管特征（包括大玻璃膜疣和RPE异常）的前瞻性研究必须考虑这些特征的出现和消失，并支持并排分级可补充独立分级以确定AMD特征出现或消失这一观点。
