Associations between Progression of Retinal Pigment Epithelial and Outer Retinal Atrophy and Choroidal Thickness: A 2-Year observation

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-09-15 DOI:10.1016/j.xops.2025.100939

Norihiro Nagai MD, PhD , Hajime Shinoda MD, PhD , Hisashi Matsubara MD, PhD , Hiroto Terasaki MD, PhD , Takao Hirano MD, PhD , Aki Kato MD, PhD , Akiko Miki MD, PhD , Hiromasa Hirai MD, PhD , Fumiko Murao MD, PhD , Hiroko Imaizumi MD, PhD , Fumi Gomi MD, PhD , Yoshinori Mitamura MD, PhD , Nahoko Ogata MD, PhD , Sentaro Kusuhara MD, PhD , Tsutomu Yasukawa MD, PhD , Toshinori Murata MD, PhD , Taiji Sakamoto MD, PhD , Mineo Kondo MD, PhD , Yoko Ozawa MD, PhD

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Abstract

Purpose

To evaluate the clinical course of retinal pigment epithelial and outer retinal atrophy (RORA) with best-corrected visual acuity (BCVA) and risk factors for rapid progression to explore the pathogenesis.

Design

Retrospective observational study.

Subjects

Data on eyes with fovea-involved RORA associated with age-related macular degeneration were collected over time from 10 hospitals in Japan.

Methods

Data on ophthalmic examination, BCVA, and OCT images were analyzed.

Main Outcome Measures

Relationships between changes in BCVA and extents of RORA and outer plexiform layer (OPL) deterioration and their associations with central choroidal thickness (CCT) and pachychoroid characteristics at baseline were evaluated.

Results

Of the 53 eyes of 53 patients (mean age; 74.9 ± 1.4 years), 32 eyes (60.4%) belonged to men. The progression in the mean extent of OPL deterioration was evident at year 1, whereas that of RORA, BCVA impairment, thinning of the central retinal thickness, and CCT became apparent at year 2 (P < 0.05). Changes in the extents of RORA and OPL deterioration and BCVA were correlated (P < 0.05). Baseline CCT negatively correlated with baseline RORA and the changes in extent of RORA (P < 0.05). After adjusting for age and sex, a longer extent of RORA at baseline predicted BCVA worsening ≥0.04 per year (odds ratio [OR], 3.444; 95% confidence interval [CI], 1.015–11.691; P = 0.047). Greater horizontal extension of RORA ≥175 μm/y was frequently observed in eyes with thinner CCT <180 μm (OR, 4.684; 95% CI, 1.288–17.036; P = 0.019), subretinal drusenoid deposits (SDDs) (OR, 6.714; 95% CI, 1.555–28.988; P = 0.011), and drusen (OR, 4.392; 95% CI, 1.176–16.410; P = 0.028) and less observed in eyes with pachychoroid characteristics (OR, 0.038; 95% CI, 0.003–0.454, P = 0.010) at baseline after adjusting for age and baseline extent of RORA; similar risks for greater vertical extension of RORA were observed.

Conclusions

The change in BCVA paralleled the changes in the extents of RORA and OPL deterioration. Rapid BCVA impairment was observed in eyes with longer RORA at baseline. A thinner choroid, SDD, and drusen were risk factors, and pachychoroid characteristics were protective factors against RORA progression. Further studies are warranted to better understand the progression of RORA and vision loss.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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视网膜色素上皮进展与视网膜外萎缩和脉络膜厚度之间的关系：一项为期2年的观察

目的评价具有最佳矫正视力（BCVA）的视网膜色素上皮和外视网膜萎缩（RORA）的临床病程及快速进展的危险因素，探讨其发病机制。设计回顾性观察性研究。研究人员从日本的10家医院收集了与年龄相关性黄斑变性相关的累及中央凹的RORA眼睛的数据。方法分析眼科检查、BCVA、OCT影像资料。评估BCVA变化与RORA和外丛状层（OPL）恶化程度的关系，以及它们与基线时中央脉络膜厚度（CCT）和厚脉络膜特征的关系。结果53例患者53眼（平均年龄74.9±1.4岁），男性32眼（60.4%）。OPL平均恶化程度的进展在第1年明显，而RORA、BCVA损伤、视网膜中央厚度变薄和CCT的进展在第2年变得明显（P < 0.05）。RORA、OPL恶化程度的变化与BCVA有相关性（P < 0.05）。基线CCT与基线RORA及RORA程度变化呈负相关（P < 0.05）。在调整年龄和性别后，基线时较长的RORA程度预测BCVA恶化≥0.04 /年（优势比[OR]， 3.444； 95%可信区间[CI]， 1.015-11.691; P = 0.047）。在调整年龄和基线RORA程度后，较薄的CCT = 180 μm （OR, 4.684, 95% CI, 1.288-17.036, P = 0.019）、视网膜下结节样沉积（SDDs）（OR, 6.714, 95% CI, 1.555-28.988, P = 0.011）和结节样沉积（OR, 4.392, 95% CI, 1.176-16.410, P = 0.028）和厚脉络膜特征的眼睛（OR, 0.038, 95% CI, 0.003-0.454, P = 0.010）常观察到RORA水平扩展≥175 μm/y （OR, 0.038, 95% CI, 0.003-0.454, P = 0.010）。RORA的垂直延伸也有类似的风险。结论BCVA的变化与RORA和OPL恶化程度的变化是平行的。在基线时RORA较长的眼睛中观察到快速BCVA损伤。脉络膜变薄、SDD和水肿是危险因素，厚脉络膜特征是防止RORA进展的保护因素。为了更好地了解RORA和视力丧失的进展，需要进一步的研究。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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