Geographic Atrophy Clinical Features and Potential Therapeutic Approaches
Geographic Atrophy Clinical Features and Potential Therapeutic Approaches
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DOI：
10.1016/j.ophtha.2013.11.023
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发表时间：
2014-05-01
期刊：
影响因子：
13.7
通讯作者：
Campagne, Menno van Lookeren
中科院分区：
文献类型：
--
作者：
Holz, Frank G.;Strauss, Erich C.;Campagne, Menno van Lookeren
湿性年龄相关性黄斑变性（AMD）的视力丧失通常是急性的，治疗导致视网膜液相对迅速减少，随后视力（VA）得到改善，与之相反，由AMD引起的地理萎缩（GA）的疾病进展和视力丧失是一个渐进的过程。虽然GA可导致阅读、夜视和黑暗适应方面的严重视觉功能缺陷，并在视野中产生致密的、不可逆的暗斑，但如果中央凹不受影响，VA的初始下降可能相对较小。由于最佳矫正的VA与GA病变或进展没有很好的相关性，因此正在寻找其他临床终点。这些包括减轻患者负担，减缓GA病变面积的扩大速度，减缓或消除中晚期AMD的进展。在这些考虑因素中，减缓GA病变区域的扩张似乎是临床合适的主要疗效终点。由于GA病变的生长以光感受器的丧失为特征，因此它被认为是视力丧失的替代终点。GA的检测可以通过许多不同的成像技术来实现，包括彩色眼底摄影、荧光素血管造影、眼底自身荧光（FAF）、近红外反射和光谱域光学相干断层扫描。先前的研究已经确定了进展率的预测特征，包括病灶周围视网膜中FAF的异常模式。虽然目前还没有批准或有效的治疗方法来预防GA的发生和发展，但临床研究正在评估潜在的治疗方法。(C) 2014年由爱思唯尔公司代表美国眼科学会出版。
In contrast to wet age-related macular degeneration (AMD), where loss of vision is typically acute and treatment leads to a relatively rapid reduction in retinal fluid and subsequent improvements in visual acuity (VA), disease progression and vision loss in geographic atrophy (GA) owing to AMD are gradual processes. Although GA can result in significant visual function deficits in reading, night vision, and dark adaptation, and produce dense, irreversible scotomas in the visual field, the initial decline in VA may be relatively minor if the fovea is spared. Because best-corrected VA does not correlate well with GA lesions or progression, alternative clinical endpoints are being sought. These include reduction in drusen burden, slowing the enlargement rate of GA lesion area, and slowing or eliminating the progression of intermediate to advanced AMD. Among these considerations, slowing the expansion of the GA lesion area seems to be a clinically suitable primary efficacy endpoint. Because GA lesion growth is characterized by loss of photoreceptors, it is considered a surrogate endpoint for vision loss. Detection of GA can be achieved with a number of different imaging techniques, including color fundus photography, fluorescein angiography, fundus autofluorescence (FAF), near-infrared reflectance, and spectral-domain optical coherence tomography. Previous studies have identified predictive characteristics for progression rates including abnormal patterns of FAF in the perilesional retina. Although there is currently no approved or effective treatment to prevent the onset and progression of GA, potential therapies are being evaluated in clinical studies. (C) 2014 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology.