A functional predictive test for age-related macular degeneration

老年性黄斑变性(AMD)是导致我们社区失明的主要原因。它是一种进行性的、起病晚的疾病，影响中央视力。在过去的50年里，15%的人出现了疾病的迹象，在接下来的每十年里，严重的视力丧失影响着越来越多的人。到90岁时，25%的人将失去明显的视力。没有预防措施，治疗选择有限，对失盲率几乎没有影响。AMD会造成巨大的个人成本，并给卫生资源带来巨大的负担。高患病率、预计老龄化人口的增加以及有限的治疗选择，突显了需要进行研究的紧迫性。AMD的早期临床症状是中央视网膜(黄斑)有称为玻璃体的黄色沉淀物和视网膜色素沉着改变。随着AMD的进展，黄斑通过萎缩(孔洞)或血管生长而受损。目前，临床上可获得的有关玻璃体和色素变化的信息被用来对疾病的严重程度进行分级，并预测进展为视力丧失的风险。这一高危人群被纳入预防和干预研究，以寻找新的干预措施。这种对临床特征的评分目前是AMD所有临床试验和流行病学研究的基础。然而，这一方案并非没有局限性，导致临床表现和失明风险之间存在不准确的相关性。我们相信，视网膜功能测试(在黑暗中看东西的能力，检测微弱光线的能力)将为识别高视力丧失风险的患者提供更好的相关性。我们的目标是在有AMD早期临床症状的受试者中测试视网膜功能的各个方面(在明暗条件下以及对运动和静止物体)，以确定对AMD视觉破坏性并发症的进展风险更敏感和更特异的预测参数。

Age-related macular degeneration (AMD) is the leading cause of blindness in our community. It is a progressive, late onset disease affecting central vision. Signs of disease are present in 15% of the population over 50 years with severe visual loss affecting increasing numbers in each subsequent decade. By 90 years 25% of people will have lost significant vision. There is no prevention, and treatment options are limited and have little impact on the rates of blindness. AMD causes enormous personal costs and places a massive burden on health resources. The high prevalence, anticipated increase in the ageing population and the limited treatment options, highlight the urgency with which research is required. The early clinical signs of AMD are yellow deposits called drusen, in the central retina (macula) and alteration in retinal pigmentation. As AMD progresses the macula is damaged either through atrophy (holes) or by growth of blood vessels. Currently, clinically accessible information about drusen and pigmentary changes are used to grade the severity of disease and predict the risk of progression to vision loss. This at risk group is recruited into prevention and intervention studies looking for new interventions. Such scoring of clinical characteristics currently underpins all clinical trials and epidemiological research in AMD. However this scheme is not without limitations, and results in an inexact correlation between clinical appearance and risk of blindness. We believe that a test of retinal function, (ability to see in the dark, to detect a faint light), will provide a better correlation for identifying patients at high risk of vision loss. We aim to test various aspects of retinal function (in both the light and dark and for moving and stationary objects) in subjects with early clinical signs of AMD, to identify parameters that will be more sensitive and specific predictors of risk of progression to visually devastating complications of AMD.