背景:晚期年龄相关性黄斑变性(AMD)是视力丧失的主要原因。因此,人们对可以预测或预防晚期AMD发病的前兆病变感兴趣.一个这样的病变是视网膜色素上皮(RPE)和布鲁赫膜(BM)的浅分离,用各种术语来描述,包括双层标志(DLS)。
方法:在本文中,我们的目的是检查和澄清不同的术语,这些术语指的是RPE和BM的浅分离。我们还回顾了与DLS相关的结果的当前证据:首先,DLS是否可以预测渗出性新生血管性AMD;其次,DLS是否具有针对地理萎缩的潜在保护特性。
结果:用于描述RPE和BM的浅分离的术语范围反映了DLS可以呈现不同的特征。虽然血管化DLS似乎可以防止萎缩,但可以进展为渗出,非血管化DLS与萎缩风险增加相关.光学相干断层扫描(OCT)血管造影(OCTA)是识别和区分各种形式的DLS的主要方法。如果OCTA不可用或实际上不可能,DLS的简化分类为厚或薄,使用OCT,使血管化的可能性接近。正在研究通过将深度学习算法应用于OCT扫描来自动化DLS检测。
结论:术语DLS仍然适用于描述RPE和BM的浅分离。该特征的检测和分类提供关于进展为晚期AMD的风险的有价值的信息。然而,DLS的出现及其在预测AMD进展中的价值在不同患者之间可能存在差异.随着进一步的研究,可以确认个性化的风险,以告知适当的治疗。
年龄相关性黄斑变性(AMD)是一种可能在老年人中发展的眼病,通常是60岁以上的人。在疾病早期,人们通常没有任何症状,但是随着疾病的发展,可能会出现视力丧失。AMD的高级形式被称为新生血管性AMD(也称为“湿性”AMD)和高级干性AMD(称为地理萎缩;GA)。重要的是在眼部扫描中识别特征和体征,以帮助预测AMD患者是否会发展为晚期疾病,因为这将帮助医生计划最合适的治疗方法。眼睛扫描上的一个这样的特征是双层符号(DLS)。在这篇文章中,我们总结了用于DLS的不同名称,并评估DLS是否会增加早期AMD患者发生湿性AMD或GA的可能性。我们得出的结论是,DLS看起来因人而异,这导致DLS被称为各种名称。患有早期AMD和含有DLS的血管的人可能更有可能发展为湿性AMD;而患有早期AMD和没有血管的DLS的人可能更有可能发展为GA。使用光学相干断层扫描血管造影成像对眼睛拍照是识别DLS和确认其是否包含血管的主要方法。
BACKGROUND: Advanced age-related macular degeneration (AMD) is a major cause of vision loss. Therefore, there is interest in precursor lesions that may predict or prevent the onset of advanced AMD. One such lesion is a shallow separation of the retinal pigment epithelium (RPE) and Bruch\'s membrane (BM), which is described by various terms, including double-layer sign (DLS).
METHODS: In this article, we aim to examine and clarify the different terms referring to shallow separation of the RPE and BM. We also review current evidence on the outcomes associated with DLS: firstly, whether DLS is predictive of exudative neovascular AMD; and secondly, whether DLS has potential protective properties against geographic atrophy.
RESULTS: The range of terms used to describe a shallow separation of the RPE and BM reflects that DLS can present with different characteristics. While vascularised DLS appears to protect against atrophy but can progress to exudation, non-vascularised DLS is associated with an increased risk of atrophy. Optical coherence tomography (OCT) angiography (OCTA) is the principal method for identifying and differentiating various forms of DLS. If OCTA is unavailable or not practically possible, simplified classification of DLS as thick or thin, using OCT, enables the likelihood of vascularisation to be approximated. Research is ongoing to automate DLS detection by applying deep-learning algorithms to OCT scans.
CONCLUSIONS: The term DLS remains applicable for describing shallow separation of the RPE and BM. Detection and classification of this feature provides valuable information regarding the risk of progression to advanced AMD. However, the appearance of DLS and its value in predicting AMD progression can vary between patients. With further research, individualised risks can be confirmed to inform appropriate treatment.
Age-related macular degeneration (AMD) is an eye disease that may develop in older people, usually those aged over 60 years. Early in the disease, people often do not show any symptoms, but as the disease progresses, vision loss may occur. The advanced forms of AMD are called neovascular AMD (also called “wet” AMD) and advanced dry AMD (called geographic atrophy; GA). It is important to identify features and signs on eye scans that can help to predict if someone with AMD will develop an advanced form of the disease because this will help doctors plan the most appropriate treatment. One such feature on eye scans is the double-layer sign (DLS). In this article, we summarise the different names used for DLS, and assess if having a DLS increases the likelihood of someone with early AMD developing wet AMD or GA. We conclude that how DLS looks varies between people, which leads to DLS being called by various names. Someone with early AMD and a DLS containing blood vessels may be more likely to develop wet AMD; whereas someone with early AMD and a DLS without blood vessels may be more likely to develop GA. Taking photos of the eye using optical coherence tomography angiography imaging is the main method of identifying DLS and confirming whether it contains blood vessels.