Peripheral Retinal Changes Associated with Age-Related Macular Degeneration in the Age-Related Eye Disease Study 2
Peripheral Retinal Changes Associated with Age-Related Macular Degeneration in the Age-Related Eye Disease Study 2
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DOI：
10.1016/j.ophtha.2016.12.004
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发表时间：
2017-04-01
期刊：
影响因子：
13.7
通讯作者：
Chew, Emily Y.
中科院分区：
文献类型：
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作者：
Domalpally, Amitha;Clemons, Traci E.;Chew, Emily Y.
目的：为了比较周边视网膜的变化率在视网膜相关性眼病研究2（AREDS 2）参与者与至少中间的年龄相关性黄斑变性（AMD）与对照组没有中间的年龄相关的变化（大玻璃疣）。设计：横断面评估的临床为基础的患者参加AREDS 2和一项前瞻性研究。参与者：来自前瞻性研究的参与者。方法：在Optos 200 Tx超宽视野设备（Optos，Dunfermline，Scotland）上通过以中央凹为中心，然后向上和向下转向来捕获200度假彩色和眼底自发荧光（FAF）图像。在阅读中心对蒙太奇图像进行分级，将图像分为3个区域（1区[后极]、2区[中周边]和3区[远周边]）以记录周边病变的存在。主要结果测量：周边视网膜病变：玻璃疣、色素减退/色素沉着改变、网状假性玻璃疣、老年性网状色素沉着改变、鹅卵石变性和FAF异常。共有484例（951只眼）患有AMD的AREDS 2参与者（病例）和89例（163只眼）没有AMD的对照者具有分级的颜色和FAF图像。在区域2和3中，存在新生血管形成和地图状萎缩（GA），在病例眼中的范围分别为0.4%至6%，对照组的GA存在于1%的眼睛中。在上级区2和3以及下级区3，分别有97%、78%和64%的病例眼和48%、21%和9%的对照眼检测到玻璃疣（均P < 0.001）。周围网状假性玻璃疣15%。老年性网状色素改变是主要的外周改变，在2区，48%的病例和16%的对照组中观察到（P < 0.001）。非网状色素的变化是不太频繁的周边比在后极（46%比76%）和可忽略不计的controls.Conclusions：周边视网膜的变化是更普遍的眼睛AMD比对照眼。玻璃疣见于大多数患有AMD的眼睛的中周边和远周边，而色素变化和晚期AMD的特征不太常见。视网膜相关性黄斑变性可能不仅仅是一种“黄斑”疾病，而是一种涉及整个视网膜的疾病。未来对AMD外周改变及其对视功能影响的纵向研究可能有助于了解AMD的发病机制。
Purpose: To compare rates of peripheral retinal changes in Age-Related Eye Disease Study 2 (AREDS2) participants with at least intermediate age-related macular degeneration (AMD) with control subjects without intermediate age-related changes (large drusen).Design: Cross-sectional evaluation of clinic-based patients enrolled in AREDS2 and a prospective study. Participants:Participants from prospective studies.Methods: The 200 degrees pseudocolor and fundus autofluorescence (FAF) images were captured on the Optos 200 Tx Ultrawide-field device (Optos, Dunfermline, Scotland) by centering on the fovea and then steering superiorly and inferiorly. The montaged images were graded at a reading center with the images divided into 3 zones (zone 1 [posterior pole], zone 2 [midperiphery], and zone 3 [far periphery]) to document the presence of peripheral lesions.Main Outcome Measures: Peripheral retinal lesions: drusen, hypopigmentary/hyperpigmentary changes, reticular pseudodrusen, senile reticular pigmentary changes, cobblestone degeneration, and FAF abnormalities.Results: A total of 484 (951 eyes) AREDS2 participants with AMD (cases) and 89 (163 eyes) controls without AMD had gradable color and FAF images. In zones 2 and 3, neovascularization and geographic atrophy (GA) were present, ranging from 0.4% to 6% in eyes of cases, respectively, and GA was present in 1% of eyes of controls. Drusen were detected in 97%, 78%, and 64% of eyes of cases and 48%, 21%, and 9% of eyes of controls in zones 2 and 3 superior and 3 inferior, respectively (P < 0.001 for all). Peripheral reticular pseudodrusen were seen in 15%. Senile reticular pigmentary change was the predominant peripheral change seen in 48% of cases and 16% of controls in zone 2 (P < 0.001). Nonreticular pigment changes were less frequent in the periphery than in the posterior pole (46% vs. 76%) and negligible in controls.Conclusions: Peripheral retinal changes are more prevalent in eyes with AMD than in control eyes. Drusen are seen in a majority of eyes with AMD in both the mid and far periphery, whereas pigment changes and features of advanced AMD are less frequent. Age-related macular degeneration may be more than a "macular" condition but one that involves the entire retina. Future longitudinal studies of peripheral changes in AMD and their impact on visual function may contribute to understanding AMD pathogenesis.