Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration
Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration
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DOI：
10.1016/s0161-6420(99)90340-8
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发表时间：
1999-09-01
期刊：
影响因子：
13.7
通讯作者：
Bergman, A
中科院分区：
文献类型：
--
作者：
Sunness, JS;Gonzalez-Baron, J;Bergman, A
目的：探讨老年性黄斑变性（AMD）的地理性萎缩（GA）与视力（VA）下降和萎缩扩大的关系。设计：前瞻性观察的病例系列。单位：三级视网膜转诊中心。参与者：每年检查123例由AMD引起的GA患者，他们完成了至少1年的随访（中位随访3年）。方法：在每次检查时，测量每只眼的最佳矫正视差，进行临床检查，并拍摄彩色眼底照片。绘制并测量萎缩区域。主要观察指标：视力下降，整体和中枢萎缩扩大。结果：在基线时，中位VA较差，萎缩面积较大，但与中央凹保留有关的差异很大。在所有的研究中，31%的眼睛在基线的2年内出现了三线VA损失，53%的眼睛在4年内出现了三线VA损失。VA > 20/50的眼视力丧失率最高；这些眼睛中27%的人在4年时的视力为20/200或更差。GA研究眼的视力损失与双侧GA患者和同侧GA患者的脉络膜新生血管相似。2年时黄斑光凝研究盘面积（DA）中位数增大1.8；以中央凹为中心的4 DA圆圈内萎缩，中位数增大0.9 DA。9例单眼GA患者中有2例（22%）在2年后发生了另一只眼GA，只有另一只眼无晚期AMD的患者发生了另一只眼GA。结论：在许多眼睛中，随着时间的推移，地理萎缩与VA显著下降有关。随着时间的推移，萎缩的区域继续扩大，即使在基线时已经很大。在大多数患者中，双侧发生的VA减少与萎缩扩大的合并可导致视觉功能的严重损害。
Objective: To describe the progression of geographic atrophy (GA) from age-related macular degeneration (AMD) with respect to visual acuity (VA) loss and enlargement of atrophy.Design: A prospectively observed case series.Setting: Tertiary retinal referral center.Participants: One hundred twenty-three patients with GA due to AMD who completed at least 1 year of follow-up (median follow-up, 3 years) were examined annually.Methods: At each examination, a protocol best-corrected VA of each eye was measured, a clinical examination was performed, and color fundus photographs were taken. The areas of atrophy were drawn and measured.Main Outcome Measures: Visual acuity loss and enlargement of total and central atrophy.Results: At baseline, median VA was poorer with larger areas of atrophy, but there was wide variation related to sparing of the fovea. Thirty-one percent of all study eyes suffered a three-line VA loss from baseline by 2 years, and 53% had a three-line loss by 4 years. Those eyes with VA better than 20/50 had the highest rate of acuity loss; 27% of these eyes had acuities of 20/200 or worse at 4 years. Visual acuity loss in the GA study eye was similar in patients with bilateral GA and in those with choroidal neovascularization in the fellow eye. Total atrophy enlarged a median of 1.8 Macular Photocoagulation Study disc areas (DA) at 2 years; atrophy within a 4-DA circle centered on the fovea enlarged a median of 0.9 DA. Two (22%) of nine patients with GA in one eye and only drusen without advanced AMD in the fellow eye developed GA in the fellow eye at 2 years.Conclusions: Geographic atrophy is associated with a significant decline in VA over time in many eyes. Areas of atrophy continue to enlarge over time, even when already large at baseline. The combination of reduced VA with enlargement of atrophy, occurring bilaterally in most patients, can lead to significant impairment of visual function.