Abera Saeed, Callum Gin, Lauren A B Hodgson, Maxime Jannaud, Xavier Hadoux, Emily K Glover, Erin E Gee, Peter van Wijngaarden, Robyn H Guymer, Zhichao Wu
{"title":"早期萎缩性老年性黄斑变性深层视觉敏感性缺陷的局部 OCT 结构相关性。","authors":"Abera Saeed, Callum Gin, Lauren A B Hodgson, Maxime Jannaud, Xavier Hadoux, Emily K Glover, Erin E Gee, Peter van Wijngaarden, Robyn H Guymer, Zhichao Wu","doi":"10.1016/j.oret.2024.12.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To determine local OCT structural correlates of deep visual sensitivity defects (threshold of ≤10 decibels on microperimetry) in early atrophic age-related macular degeneration (AMD).</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Participants: </strong>Forty eyes from 40 participants, with at least incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA), or more advanced atrophic lesion(s).</p><p><strong>Methods: </strong>Participants underwent at least two targeted, high-density microperimetry tests of atrophic lesions of interest in one eye, and high-density 3×3 mm volume scans of that region on a swept-source OCT angiography device, all at a single visit. Seven OCT-defined features of atrophy were manually annotated: hypertransmission, RPE attenuation/disruption, complete RPE loss, ellipsoid zone (EZ) disruption, external limiting membrane (ELM) disruption, subsidence of the outer plexiform layer (OPL) and inner nuclear layer (INL), and/or hyporeflective wedge-shaped band, and outer nuclear layer (ONL) thickness.</p><p><strong>Main outcome measures: </strong>Association between OCT-defined features of atrophy and presence of a deep visual sensitivity defect at a local, pointwise level.</p><p><strong>Results: </strong>All OCT-defined features of atrophy were individually associated with the presence of a deep visual sensitivity defect at a pointwise level in univariable mixed-effects logistic regression analyses (P < 0.001 for all). However, only hypertransmission, complete RPE loss, ELM disruption, and ONL thickness remained significantly and independently associated with deep visual sensitivity defects in a multivariable analysis (P ≤ 0.011). A prediction model incorporating these four OCT features (partial area under the curve [pAUC] at ≥90% specificity = 0.80) outperformed models using any single feature alone in predicting the presence of deep visual sensitivity defects (pAUC = 0.65 to 0.78 respectively; P ≥ 0.040).</p><p><strong>Conclusions: </strong>The study identified hypertransmission, complete RPE loss, ELM disruption, and ONL thickness as key OCT-defined features of atrophy independently associated with deep visual sensitivity defects. These findings are important when considering anatomical outcome measures for evaluating interventions for early atrophic AMD that are most likely to capture beneficial treatment effects that will be accompanied by evidence of functional preservation if measured directly.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. 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Seven OCT-defined features of atrophy were manually annotated: hypertransmission, RPE attenuation/disruption, complete RPE loss, ellipsoid zone (EZ) disruption, external limiting membrane (ELM) disruption, subsidence of the outer plexiform layer (OPL) and inner nuclear layer (INL), and/or hyporeflective wedge-shaped band, and outer nuclear layer (ONL) thickness.</p><p><strong>Main outcome measures: </strong>Association between OCT-defined features of atrophy and presence of a deep visual sensitivity defect at a local, pointwise level.</p><p><strong>Results: </strong>All OCT-defined features of atrophy were individually associated with the presence of a deep visual sensitivity defect at a pointwise level in univariable mixed-effects logistic regression analyses (P < 0.001 for all). However, only hypertransmission, complete RPE loss, ELM disruption, and ONL thickness remained significantly and independently associated with deep visual sensitivity defects in a multivariable analysis (P ≤ 0.011). A prediction model incorporating these four OCT features (partial area under the curve [pAUC] at ≥90% specificity = 0.80) outperformed models using any single feature alone in predicting the presence of deep visual sensitivity defects (pAUC = 0.65 to 0.78 respectively; P ≥ 0.040).</p><p><strong>Conclusions: </strong>The study identified hypertransmission, complete RPE loss, ELM disruption, and ONL thickness as key OCT-defined features of atrophy independently associated with deep visual sensitivity defects. 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引用次数: 0
摘要
目的:确定早期萎缩性年龄相关性黄斑变性(AMD)中深层视觉敏感性缺陷(微观视力测定阈值≤10分贝)的局部OCT结构相关性:前瞻性观察研究:40名参与者的40只眼睛,至少有不完全视网膜色素上皮(RPE)和视网膜外层萎缩(iRORA),或更晚期的萎缩性病变:方法:参试者在一次就诊中至少对一只眼睛的相关萎缩病变进行两次有针对性的高密度显微视力测试,并在扫源 OCT 血管造影设备上对该区域进行 3×3 毫米的高密度体积扫描。人工标注了七种 OCT 定义的萎缩特征:高透射、RPE 衰减/破坏、RPE 完全缺失、椭圆形区(EZ)破坏、外限膜(ELM)破坏、外丛状层(OPL)和内核层(INL)下陷和/或低反射楔形带以及外核层(ONL)厚度:主要结果测量:OCT定义的萎缩特征与局部、点状深层视觉敏感度缺陷之间的关联:结果:在单变量混合效应逻辑回归分析中,OCT定义的所有萎缩特征都与点上出现深度视觉敏感度缺陷有关(P<0.001)。然而,在多变量分析中,只有高透射、RPE 完全缺失、ELM 破坏和 ONL 厚度仍与深度视觉敏感性缺陷有显著的独立相关性(P ≤ 0.011)。在预测深部视觉灵敏度缺陷方面,包含这四个 OCT 特征的预测模型(特异性≥90% 时的部分曲线下面积 [pAUC] = 0.80)优于单独使用任何一个特征的模型(pAUC = 0.65 至 0.78,P≥0.040):该研究发现,高透射、RPE完全缺失、ELM破坏和ONL厚度是OCT定义的萎缩的关键特征,与深度视敏度缺陷独立相关。这些研究结果对于评估早期萎缩性黄斑变性的干预措施时考虑解剖学结果指标非常重要,这些指标最有可能捕捉到有益的治疗效果,如果直接测量,这些效果将伴随着功能保护的证据。
Local OCT Structural Correlates of Deep Visual Sensitivity Defects in Early Atrophic Age-Related Macular Degeneration.
Purpose: To determine local OCT structural correlates of deep visual sensitivity defects (threshold of ≤10 decibels on microperimetry) in early atrophic age-related macular degeneration (AMD).
Design: Prospective observational study.
Participants: Forty eyes from 40 participants, with at least incomplete retinal pigment epithelium (RPE) and outer retinal atrophy (iRORA), or more advanced atrophic lesion(s).
Methods: Participants underwent at least two targeted, high-density microperimetry tests of atrophic lesions of interest in one eye, and high-density 3×3 mm volume scans of that region on a swept-source OCT angiography device, all at a single visit. Seven OCT-defined features of atrophy were manually annotated: hypertransmission, RPE attenuation/disruption, complete RPE loss, ellipsoid zone (EZ) disruption, external limiting membrane (ELM) disruption, subsidence of the outer plexiform layer (OPL) and inner nuclear layer (INL), and/or hyporeflective wedge-shaped band, and outer nuclear layer (ONL) thickness.
Main outcome measures: Association between OCT-defined features of atrophy and presence of a deep visual sensitivity defect at a local, pointwise level.
Results: All OCT-defined features of atrophy were individually associated with the presence of a deep visual sensitivity defect at a pointwise level in univariable mixed-effects logistic regression analyses (P < 0.001 for all). However, only hypertransmission, complete RPE loss, ELM disruption, and ONL thickness remained significantly and independently associated with deep visual sensitivity defects in a multivariable analysis (P ≤ 0.011). A prediction model incorporating these four OCT features (partial area under the curve [pAUC] at ≥90% specificity = 0.80) outperformed models using any single feature alone in predicting the presence of deep visual sensitivity defects (pAUC = 0.65 to 0.78 respectively; P ≥ 0.040).
Conclusions: The study identified hypertransmission, complete RPE loss, ELM disruption, and ONL thickness as key OCT-defined features of atrophy independently associated with deep visual sensitivity defects. These findings are important when considering anatomical outcome measures for evaluating interventions for early atrophic AMD that are most likely to capture beneficial treatment effects that will be accompanied by evidence of functional preservation if measured directly.