The risk and natural course of age-related maculopathy - Follow-up at 61/2 years in the Rotterdam study
The risk and natural course of age-related maculopathy - Follow-up at 61/2 years in the Rotterdam study
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DOI：
10.1001/archopht.121.4.519
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发表时间：
2003-04-01
影响因子：
--
通讯作者：
de Jong, PTVM
中科院分区：
文献类型：
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作者：
van Leeuwen, R;Klaver, CCW;de Jong, PTVM
目的：评估年龄相关性黄斑病变（ARM）的自然病程，并评估其最终阶段——年龄相关性黄斑变性（AMD）的发病率和绝对风险。方法：在一项基于人群的前瞻性队列研究中，我们研究了6418名55岁及以上的人的发病率和自然病程。受试者在基线和随访2.0年和6年（1/2）时接受相同的检查，包括眼底立体摄影。年龄相关性黄斑病变按照ARM和AMD的国际分级系统进行分级，并分为5个单独的阶段。发病率以发病率和5年绝对风险表示。结果：随访发现新发AMD 47例，血管性萎缩性AMD比例为1.4:1。对于年龄在55岁及以上且有不明显的水肿和色素不规则的患者，AMD的5年风险随着病情加重而增加，达到28.0%（第3期）。对于80岁及以上的3期ARM患者，年龄（而非性别）独立增加了这种风险，最高可达42.0%。预测AMD发展最好的单个ARM眼底征候是10个或更多的大结节（125 mm）和结节覆盖的栅格面积的10%或更多。发生萎缩性AMD的受试者与发生新血管性AMD的受试者相比，基线眼底体征和自然病程无显著差异（P= 0.25）。结论：我们提供了AMD的绝对风险是年龄和早期ARM眼底体征的函数，并表明两者都是突出的独立危险因素。在第一个软瘤出现后，ARM阶段的进展遵循一个明显的渐进过程，随着年龄的增长而加速。眼科杂志。2003;121:519-526。
Objectives: To evaluate the natural course of age-related maculopathy (ARM) and to assess the incidence and absolute risk of its final stage, age-related macular degeneration (AMD).Methods: In a population-based prospective cohort study of 6418 persons 55 years and older, we studied the incidence and natural course of ARM. Subjects underwent identical examinations, including stereoscopic fundus photography, at baseline and at 2.0 and 6(1/2) years' follow-up. Age-related maculopathy was graded according to the International Classification and Grading System for ARM and AMD, and stratified into 5 exclusive stages. Incidence was expressed in rates and 5-year absolute risks.Results: At follow-up, 47 new cases of AMD were identified, with a ratio of neovascular-atrophic AMD of 1.4:1. The 5-year risk of AMD increased with more severe stages to 28.0% for subjects 55 years and older with indistinct drusen and pigmentary irregularities (stage 3). Age, but not sex, independently increased this risk to a maximum of 42.0% for subjects with stage 3 ARM who were 80 years and older. Individual ARM fundus signs that predicted best the development of AMD were 10 or more large drusen (125 mm) and 10% or more of the grid area covered by drusen. Subjects who developed atrophic AMD showed no significant (P=.25) differences in baseline fundus signs and natural course compared with subjects who developed neovascular AMD.Conclusions: We provide the absolute risk of AMD as a function of age and early ARM fundus signs, and showed that both are prominent independent risk factors. The progression of ARM stages follows, after the appearance of the first soft drusen, a distinct course at a gradual pace that accelerates with increasing age. Arch Ophthalmol. 2003;121:519-526.