Enlargement of Geographic Atrophy From First Diagnosis to End of Life
Enlargement of Geographic Atrophy From First Diagnosis to End of Life
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DOI：
10.1001/jamaophthalmol.2021.1407
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发表时间：
2021-05-20
影响因子：
8.1
通讯作者：
Klaver, Caroline C. W.
中科院分区：
文献类型：
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作者：
Colijn, Johanna M.;Liefers, Bart;Klaver, Caroline C. W.
地图状萎缩（GA）是年龄相关性黄斑变性（AMD）的晚期，目前正在开发治疗方法。了解自然过程是优化试验设计所必需的。虽然GA和视力（VA）在短期内的扩大率是已知的从临床研究，扩大的长期知识，预期寿命，和视觉course. ObjectiveTo确定GA的长期扩大。设计，设置，和参与者在这项研究中，参与者的数据收集了4个人口为基础的队列研究，随访时间长达25年，每隔5年进行眼科检查：鹿特丹研究队列1、2和3以及蓝山眼科研究。数据收集时间为1990 - 2015年，分析时间为2019年1月-2020年11月。主要结果和指标使用所有可用成像逐像素测量GA面积。评估面积扩大和平方根转换面积的扩大、GA到达中央凹的时间和死亡的时间，并且根据三大洲AMD协会分类（威斯康星州年龄相关性黄斑病变分级系统的修改版本）的最佳校正的VA、吸烟状态、黄斑病变和AMD遗传变体是斯皮尔曼，皮尔逊，结果171例患者中，106例（62.0%）为女性，平均（SD）年龄为82.6（7.1）岁。在我们的研究中，242只患眼中共有147只（60.7%）是新诊断的GA。首次出现时GA的平均面积为3.74 mm（2）（95% CI，3.11-4.67）。不同人群的膨胀率差异很大（每年0.02至4.05 mm（2）），平均每年1.09 mm（2）（95% CI，0.89-1.30）。另一只眼的AMD分期与GA增大相关（斯皮尔曼rho = 0.34; P = 0.01）。在147只眼睛中的55只（37.4%）中，在发生GA时已经存在中心凹受累; 42只眼睛中的23只（55%）在平均（范围）5.6（3-12）年后发生了这种情况，42只眼睛中的11只（26%）在死亡前没有发生中心凹受累。首次诊断后，171例GA患者中有121例（70.8%）在平均（SD）6.4（5.4）年后死亡。视觉功能受损（小于20/63），在47 107例（43.9%）在最后一次访问前death.CONCLUSIONS和相关性在这项研究中，扩大GA似乎是高度可变的一般人群。超过三分之一的事件GA是中央凹在第一次介绍，那些与中央凹外GA开发中央凹GA后，平均5.6年。未来的干预试验应该集中在招募那些在预期寿命内有很大机会发生严重视力下降的患者。
IMPORTANCE Treatments for geographic atrophy (GA), a late stage of age-related macular degeneration (AMD), are currently under development. Understanding the natural course is needed for optimal trial design. Although enlargement rates of GA and visual acuity (VA) in the short term are known from clinical studies, knowledge of enlargement in the long term, life expectancy, and visual course is lacking.OBJECTIVE To determine long-term enlargement of GA.DESIGN, SETTING, AND PARTICIPANTS In this study, participant data were collected from 4 population-based cohort studies, with up to 25 years of follow-up and eye examinations at 5-year intervals: the Rotterdam Study cohorts 1, 2, and 3 and the Blue Mountains Eye Study. Data were collected from 1990 to 2015, and data were analyzed from January 2019 to November 2020.MAIN OUTCOMES AND MEASURES Area of GA was measured pixel by pixel using all available imaging. Area enlargement and enlargement of the square root-transformed area, time until GA reached the central fovea, and time until death were assessed, and best-corrected VA, smoking status, macular lesions according to the Three Continent AMD Consortium classification, a modified version of the Wisconsin age-related maculopathy grading system, and AMD genetic variants were covariates in Spearman, Pearson, or Mann-Whitney analyses.RESULTS Of 171 included patients, 106 (62.0%) were female, and the mean (SD) age at inclusion was 82.6 (7.1) years. A total of 147 of 242 eyes with GA (60.7%) were newly diagnosed in our study. The mean area of GA at first presentation was 3.74 mm(2) (95% CI, 3.11-4.67). Enlargement rate varied widely between persons (0.02 to 4.05 mm(2) per year), with a mean of 1.09 mm(2) per year (95% CI, 0.89-1.30). Stage of AMD in the other eye was correlated with GA enlargement (Spearman rho = 0.34; P = .01). Foveal involvement was already present in incident GA in 55 of 147 eyes (37.4%); 23 of 42 eyes (55%) developed this after a mean (range) period of 5.6 (3-12) years, and foveal involvement did not develop before death in 11 of 42 eyes (26%). After first diagnosis, 121 of 171 patients with GA (70.8%) died after a mean (SD) period of 6.4 (5.4) years. Visual function was visually impaired (less than 20/63) in 47 of 107 patients (43.9%) at last visit before death.CONCLUSIONS AND RELEVANCE In this study, enlargement of GA appeared to be highly variable in the general population. More than one-third of incident GA was foveal at first presentation; those with extrafoveal GA developed foveal GA after a mean of 5.6 years. Future intervention trials should focus on recruiting those patients who have a high chance of severe visual decline within their life expectancy.