Delayed Rod-Mediated Dark Adaptation Is a Functional Biomarker for Incident Early Age-Related Macular Degeneration.
Delayed Rod-Mediated Dark Adaptation Is a Functional Biomarker for Incident Early Age-Related Macular Degeneration.
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DOI：
10.1016/j.ophtha.2015.09.041
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发表时间：
2016-02
期刊：
影响因子：
13.7
通讯作者：
Curcio CA
中科院分区：
文献类型：
--
作者：
Owsley C;McGwin G Jr;Clark ME;Jackson GR;Callahan MA;Kline LB;Witherspoon CD;Curcio CA
研究基线时黄斑健康正常的成年人视杆细胞介导的暗适应是否与3年后年龄相关性黄斑变性（AMD）的发病率相关。前瞻性队列从初级保健眼科诊所招募≥ 60岁的成人。根据经验丰富且设盲的评估者对彩色眼底照片进行的分级，要求双眼在AREDS 9步AMD分类系统中为1级（正常）。使用计算机化暗适应计在光漂白后的一只眼睛中在基线处评估视杆介导的暗适应，其中目标在下垂直子午线上以5°为中心。暗适应速度通过视杆截距值表征，异常暗适应定义为视杆截距≥ 12.3分钟。人口统计学特征，最佳矫正视力和吸烟状况也进行了评估。对数二项回归用于计算基线暗适应和AMD事件之间关联的未校正和校正风险比（RR）和相关95%置信区间（CI）。基线时暗适应测试眼在3年随访访视时是否存在AMD。325人（平均年龄67.8岁）完成了基线和随访。在基线时，263名参与者的暗适应正常，平均视杆细胞截距为9.1（SD 1.5），62名参与者的暗适应异常，平均视杆细胞截距为15.1（SD 4.0）。校正年龄和吸烟后，基线时受试眼暗适应异常的受试者在随访访视时患AMD的可能性几乎是基线时暗适应正常的受试者的2倍（RR 1.92，95% CI 1.03-3.62）。正常黄斑健康的老年人中延迟的视杆细胞介导的暗适应与三年后的早期AMD事件相关，因此是早期疾病的功能性生物标志物。该测试的生物相关性很高，因为它评估了维生素A衍生物穿过视网膜色素上皮和布鲁赫膜的易位，这两种组织具有显著的年龄和AMD相关病理。
To examine whether slowed rod-mediated dark adaptation in adults in normal macular health at baseline is associated with the incidence of age-related macular degeneration (AMD) three years later. Prospective cohort Adults ≥ 60 years old were recruited from primary care ophthalmology clinics. Both eyes were required to be step 1 (normal) on the AREDS 9-step AMD classification system based on color fundus photographs graded by experienced and masked evaluators. Rod-mediated dark adaptation was assessed at baseline in one eye following a photobleach using a computerized dark adaptometer with targets centered at 5° on the inferior vertical meridian. Speed of dark adaptation was characterized by the rod-intercept value, with abnormal dark adaptation defined as rod-intercept ≥ 12.3 minutes. Demographic characteristics, best-corrected visual acuity, and smoking status were also assessed. Log-binomial regression was used to calculate unadjusted and adjusted risk ratios (RRs) and associated 95% confidence intervals (CIs) for the association between baseline dark adaptation and incident AMD. AMD presence at the three-year follow-up visit for the eye tested for dark adaptation at baseline. Both baseline and follow-up visits were completed by 325 persons (mean age 67.8 years). At baseline 263 participants had normal dark adaptation with mean rod intercept of 9.1 (SD 1.5), and 62 had abnormal dark adaptation with mean rod intercept of 15.1 (SD 4.0). After adjustment for age and smoking, those with abnormal dark adaptation in the tested eye at baseline were almost 2 times more likely to have AMD in that eye (RR 1.92, 95% CI 1.03-3.62) by the time of the follow-up visit, as compared to those who had normal dark adaptation at baseline. Delayed rod-mediated dark adaptation in older adults in normal macular health is associated with incident early AMD three years later, and thus is a functional biomarker for early disease. The biological relevance of this test is high, because it assesses translocation of vitamin A derivatives across the retinal pigment epithelium and Bruch's membrane, two tissues with prominent age- and AMD-related pathology.