The Progression of Geographic Atrophy Secondary to Age-Related Macular Degeneration
The Progression of Geographic Atrophy Secondary to Age-Related Macular Degeneration
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DOI：
10.1016/j.ophtha.2017.08.038
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发表时间：
2018-03-01
期刊：
影响因子：
13.7
通讯作者：
Ferrara, Daniela
中科院分区：
文献类型：
--
作者：
Fleckenstein, Monika;Mitchell, Paul;Ferrara, Daniela
地图状萎缩（GA）是一种晚期形式的年龄相关性黄斑变性（AMD），导致进行性和不可逆的视觉功能丧失。地图状萎缩定义为视网膜外层存在明显分界的萎缩性病变，其由光感受器、视网膜色素上皮（RPE）和下层脉络膜毛细血管的丧失引起。这些病变通常首先出现在中心凹周围黄斑，最初不包括中心凹中心，并且随着时间的推移经常扩展和合并以包括中心凹。虽然GA进展的动力学在个体患者中高度可变，但越来越多的证据表明，特定特征在预测疾病进展和结局方面可能很重要。本文综述了目前对AMD中GA进展的理解以及已知或假设与GA病变扩大相关的因素，包括受影响的眼睛和对侧眼睛的特征。此外，遗传，环境和人口因素在GA病变扩大的作用进行了讨论。总体而言，文献中报告的总研究人群的GA进展率范围为0.53至2.6 mm（2）/年（中位数，类似于1.78 mm（2）/年），主要通过彩色眼底照相或眼底自发荧光（FAF）成像进行评估。可以告知个体疾病预后的几个因素已在多个队列中重复：基线病变大小、病变位置、多灶性、FAF模式和对侧眼状态。由于最佳矫正视力并不直接对应于可能的中央凹保留导致的GA病变扩大，因此正在探索替代评估以捕获解剖进展与视功能下降之间的关系，包括微视野检查、低亮度视力、阅读速度评估和患者报告的结局。了解GA进展及其个体变异性对于临床研究的设计、临床试验结果的解释和应用以及就疾病进展如何影响其个体预后向患者提供咨询至关重要。(C)2017年由美国眼科学会。
Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) that leads to progressive and irreversible loss of visual function. Geographic atrophy is defined by the presence of sharply demarcated atrophic lesions of the outer retina, resulting from loss of photoreceptors, retinal pigment epithelium (RPE), and underlying choriocapillaris. These lesions typically appear first in the perifoveal macula, initially sparing the foveal center, and over time often expand and coalesce to include the fovea. Although the kinetics of GA progression are highly variable among individual patients, a growing body of evidence suggests that specific characteristics may be important in predicting disease progression and outcomes. This review synthesizes current understanding of GA progression in AMD and the factors known or postulated to be relevant to GA lesion enlargement, including both affected and fellow eye characteristics. In addition, the roles of genetic, environmental, and demographic factors in GA lesion enlargement are discussed. Overall, GA progression rates reported in the literature for total study populations range from 0.53 to 2.6 mm(2)/year (median, similar to 1.78 mm(2)/year), assessed primarily by color fundus photography or fundus autofluorescence (FAF) imaging. Several factors that could inform an individual's disease prognosis have been replicated in multiple cohorts: baseline lesion size, lesion location, multifocality, FAF patterns, and fellow eye status. Because best-corrected visual acuity does not correspond directly to GA lesion enlargement due to possible foveal sparing, alternative assessments are being explored to capture the relationship between anatomic progression and visual function decline, including microperimetry, low-luminance visual acuity, reading speed assessments, and patient-reported outcomes. Understanding GA progression and its individual variability is critical in the design of clinical studies, in the interpretation and application of clinical trial results, and for counseling patients on how disease progression may affect their individual prognosis. (C) 2017 by the American Academy of Ophthalmology.