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Abstract：
Background/Objectives: Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) leading to the progressive and irreversible loss of visual function. Characteristics of GA include atrophic lesions resulting from the loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. During GA progression, atrophic lesions typically advance from the macular periphery to the center, affecting foveal light sensitivity and visual acuity. This study analyzed changes in light sensitivity and visual acuity during the natural course of GA progression using the topographic analysis of structural and functional changes based on Early Treatment Diabetic Retinopathy Study (ETDRS) charts, multimodal imaging, and microperimetry assessment. Methods: Medical chart data of GA patients between 2014 and 2022 from the Internationale Innovative Ophthalmochirurgie GbR (I.I.O.) research center (Düsseldorf, Germany) were retrospectively analyzed. All patient eyes fulfilling the phase 3 OAKS study inclusion criteria were included and followed up for 60 months. The imputation of missing measurements and dropouts was performed by linear mixed models. Results: A total of 20 GA eyes from 13 GA patients were included in the study. At the index, 53.8% of patients had bilateral GA, with 70.0% of the eyes showing multifocal GA and 30.0% subfoveal encroachment (SFE). A total of 35.0% of the eyes had 2-5, and 15.0% over 20, areas of atrophy. Over time, the GA lesion size increased from 6.4 mm2 to 11.8 mm2 (1.08 mm2/year). After an average observation time of 2.9 years, 78.6% of the initially unaffected study eyes developed SFE. The percentage of study eyes without visual impairment decreased from 55.0% to 30.0%, with mean normal-luminance best-corrected visual acuity (NL-BCVA) reducing from 63.7 to 55.7 ETDRS letters. The share of absolute scotoma points in microperimetry assessment increased from 15.7% to 43.5% while overall average macular sensitivity declined from 15.7 dB to 7.4 dB. Conclusions: The substantial deterioration of macular outcomes and visual function was comprehensively detected. The results were a documentation of structural and functional aspects of the natural progression of GA for a 60-month follow-up, providing a typical outline for AMD patients with GA.
摘要：
背景/目的：地理萎缩（GA）是老年性黄斑变性（AMD）的一种晚期形式，可导致视觉功能的进行性和不可逆的丧失。GA的特征包括由于光感受器丢失而导致的萎缩性病变，视网膜色素上皮,和脉络膜乳头病。在GA进展期间，萎缩性病变通常从黄斑周围进展到中心，影响中央凹的光敏感度和视敏度。这项研究使用基于早期治疗糖尿病视网膜病变研究（ETDRS）图表的结构和功能变化的地形图分析，分析了GA进展的自然过程中光敏感性和视敏度的变化。多模态成像,和显微视野评估。方法：2014年至2022年国际创新眼科GbR（I.I.O.）研究中心（杜塞尔多夫，德国）进行了回顾性分析。纳入符合3期OAKS研究纳入标准的所有患者眼睛，并随访60个月。通过线性混合模型进行缺失测量和丢失的填补。结果：共有来自13名GA患者的20只眼被纳入研究。在索引中，53.8%的患者有双侧GA，70.0％的眼睛显示多灶性GA和30.0％的中央凹下侵犯（SFE）。总共35.0%的眼睛有2-5个萎缩区域，15.0%超过20个萎缩区域。随着时间的推移,GA病变大小从6.4mm2增加到11.8mm2(1.08mm2/年)。经过2.9年的平均观测时间，78.6%的最初未受影响的研究眼睛发展为SFE。没有视力障碍的研究眼睛的百分比从55.0％下降到30.0％，平均正常亮度最佳矫正视力（NL-BCVA）从63.7个降低到55.7个ETDRS字母。绝对暗点在显微视野评估中的份额从15.7％增加到43.5％，而总体平均黄斑敏感性从15.7dB下降到7.4dB。结论：全面检测黄斑预后和视功能的实质性恶化。结果记录了60个月随访的GA自然进展的结构和功能方面，为患有GA的AMD患者提供了一个典型的轮廓。
