Structure function correlation of high resolution retinal imaging in early age-related macular degeneration and physiological aging

虽然老年性黄斑变性（AMD）是发达国家致盲的主要原因，也是眼科学研究的主要焦点，但其发病机制尚不完全清楚。中央视网膜最初的细微变化通常在50岁以后出现。对于新生血管性疾病晚期（黄斑新生血管，MNV），玻璃体内抗vegf药物（血管内皮生长因子）的应用已取得成功。对于干性晚期（地理萎缩，GA），迄今为止没有治疗选择。因此，目标必须是在早期阶段将生理性老化的眼睛与发展中的AMD区分开来，以便在晚期阶段发展之前为他们提供可能的预防措施。目前，人们正在讨论所谓的发病机制“中心-环绕模型”。在这里，我们假设锥体光感受器弹性的中心焦点，由<s:1> ller细胞和黄斑黄叶素的浓度介导，被杆状光感受器脆弱性包围，由黄斑黄叶素色素的缺乏和drusen的增加介导，这限制了视网膜色素上皮和绒毛膜毛细血管之间的营养物质交换。本研究项目的目的是进一步验证这一“中心-环绕模型”。利用自然历史研究ALSTAR-2中收集的数据，现代高分辨率成像（光学相干断层扫描[OCT]，荧光终身眼科检查[FLIO]，黄斑色素密度测量[MPOD]）和视网膜功能的详细评估（Rod介导的暗适应，RMDA）将用于研究生理老化的眼睛与amd发育的眼睛在多大程度上不同。此外，调查问卷将用于调查研究参与者的营养习惯是否以及在多大程度上影响血清中测量的叶黄素水平。目前的研究项目可以分为四个不同的工作包：1)分析ETDRS网格区域个体视网膜厚度对FLIO信号的影响。2)分析ETDRS网格区域内个体视网膜层厚度对MPOD信号的影响。3)分析FLIO和MPOD信号与测试位点区域RMDA值之间可能存在的相关性。4)分析研究对象的营养习惯对ETDRS网格区血清叶黄素水平和MPOD测量的影响。如果进一步验证包括血清叶黄素水平对FLIO/MPOD信号和RMDA测试值的影响的中心-环绕模型成功，并且发现饮食习惯与叶黄素水平和MPOD测量之间的关联，将为早期AMD患者预防和减少AMD进展提出新的行为建议。

Although age-related macular degeneration (AMD) is the leading cause of blindness in the developed world and has long been a major focus of research in ophthalmology, its pathogenesis is yet to be fully understood. First subtle changes in the central retina usually develop after the age of 50. For the neovascular late disease stage (macular neovascularization, MNV) there is a successful therapy with the application of intravitreal anti-VEGF agents (vascular endothelial growth factor). For the dry late stage (geographic atrophy, GA) there are no therapeutic options so far. Therefore, the goal must be to distinguish physiologically aging eyes from those developing AMD at an early stage in order to provide them with possible preventive measures before one of the late stages develops. Currently, the so-called "center-surround model" of pathogenesis is being discussed. Here it is postulated that a central focus of the cone photoreceptors resilience, mediated by a concentration of Müller cells and xanthophyll macular pigment, is surrounded by a rod photoreceptor vulnerability, mediated by a lack of xanthophyll macular pigment and an increased occurrence of drusen, which limit the exchange of nutrients between retinal pigment epithelium and choriocapillaris. The aim of the present research project is to further validate this "center-surround model". Using data collected in the natural history study ALSTAR-2, modern high-resolution imaging (optical coherence tomography [OCT], fluorescence lifetime ophthalmoscopy [FLIO], macular pigment density measurements [MPOD]) and detailed assessments of retinal function (Rod mediated dark adaptation, RMDA) will be used to investigate to what extent physiologically aging eyes differ from AMD-developing eyes. In addition, questionnaires will be used to investigate whether and to what extent nutritional habits of the study participants affect xanthophyll levels measured in blood serum. The present research project can be divided into four distinct work packages: 1) Analysis of the influence of individual retinal thicknesses in the ETDRS grid region on the FLIO signal. 2) Analysis of the influence of individual retinal layer thicknesses in the area of the ETDRS grid on the MPOD signal. 3) Analysis of a possible correlation between FLIO and MPOD signal and RMDA values in the area of the test loci. 4) Analysis of the influence of study participants' nutritional habits on serum xanthophyll levels and MPOD measurements in the ETDRS grid area. If further validation of the center-surround model including the influence of serum xanthophyll levels on FLIO/MPOD signal and RMDA test values is successful and an association of dietary habits with xanthophyll levels and MPOD measurements is found, new behavioral recommendations for AMD prevention and reduction of progression of early-stage AMD patients will be developed.