A functional predictive test for age-related macular degeneration

视网膜相关性黄斑变性（AMD）是我们社区失明的主要原因。它是一种影响中央视力的进行性、迟发性疾病。50岁以上的人群中有15%存在疾病迹象，在随后的每十年中，严重的视力丧失影响越来越多的人。到90岁时，25%的人将失去重要的视力。没有预防措施，治疗选择有限，对失明率影响不大。AMD造成巨大的个人成本，并对卫生资源造成巨大负担。高发病率、老龄化人口的预期增加以及有限的治疗选择，突出表明迫切需要进行研究。AMD的早期临床体征是在中央视网膜（黄斑）中的称为玻璃疣的黄色沉积物和视网膜色素沉着的改变。随着AMD的进展，黄斑通过萎缩（孔）或血管生长而受损。目前，临床上可获得的关于玻璃疣和色素沉着变化的信息用于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。这一高危群体被招募到预防和干预研究中，寻找新的干预措施。这种临床特征的评分目前支持AMD的所有临床试验和流行病学研究。然而，该方案并非没有限制，并且导致临床表现与失明风险之间的不精确相关性。我们相信，视网膜功能的测试（在黑暗中看东西的能力，检测微弱的光线）将为识别视力丧失高风险患者提供更好的相关性。我们的目标是测试具有AMD早期临床体征的受试者的视网膜功能的各个方面（在明亮和黑暗中以及对于移动和静止物体），以确定将是AMD视觉破坏性并发症进展风险的更敏感和具体的预测因子的参数。

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.