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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.26074

摘要内容如下：

重要性

年龄相关性黄斑变性（AMD）在美国影响大约2000万人，在全世界影响1.96亿人。AMD是导致老年人严重视力损害的主要原因，预计到2040年，全球将有约2.88亿人受到影响。

观察

年龄较大、遗传因素和环境因素（如吸烟）与AMD的发生有关。当细胞外沉积物在视网膜外层积聚时，AMD就会发生，最终导致光感受器退化和中心视力丧失。晚期AMD的特征在于外部视网膜萎缩，称为地图状萎缩，或与视网膜下和/或视网膜内渗出相关的新血管形成，称为渗出性新血管AMD。AMD的年发病率从55至59岁人群的0.3/1000到90岁或以上人群的36.7/1000不等。晚期AMD的估计遗传度约为71%（95%CI，18%-88%）。长期前瞻性队列研究显示，与从不吸烟的人相比，每天吸烟超过20支的人的AMD发病率显著较高。AMD的诊断主要是通过临床检查，包括通过瞳孔聚焦裂隙灯光线的特殊透镜。渗出性新生血管性AMD最好使用血管造影术和光学相干断层扫描来识别。服用由高剂量维生素C、维生素E、类胡萝卜素和锌组成的营养补充剂的AMD患者在5年内发展为晚期AMD的概率为20%，而服用安慰剂的患者为28%。在渗出性新生血管性AMD中，每月接受玻璃体内抗血管内皮生长因子（anti-VEGF）注射的患者中，94.6%在12个月后视力下降少于15个字母，而接受假治疗的患者中，这一比例为62.2%。

结论和相关性

预计到2040年，全球AMD的患病率将增加到2.88亿人。玻璃体内注射抗VEGF治疗是渗出性新生血管性AMD的一线治疗。

英文原文如下：

Abstracts

Importance  Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide. AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million people worldwide by 2040.

Observations  Older age, genetic factors, and environmental factors, such as cigarette smoking, are associated with development of AMD. AMD occurs when extracellular deposits accumulate in the outer retina, ultimately leading to photoreceptor degeneration and loss of central vision. The late stages of AMD are characterized by outer retinal atrophy, termed geographic atrophy, or neovascularization associated with subretinal and/or intraretinal exudation, termed exudative neovascular AMD. The annual incidence of AMD ranges from 0.3 per 1000 in people who are aged 55 to 59 years to 36.7 per 1000 in people aged 90 years or older. The estimated heritability of late-stage AMD is approximately 71% (95% CI, 18%-88%). Long-term prospective cohort studies show a significantly higher AMD incidence in people who smoke more than 20 cigarettes per day compared with people who never smoked. AMD is diagnosed primarily with clinical examination that includes a special lens that focuses light of the slit lamp through the pupil. Exudative neovascular AMD is best identified using angiography and by optical coherence tomography. Individuals with AMD who take nutritional supplements consisting of high-dose vitamin C, vitamin E, carotenoids, and zinc have a 20% probability to progress to late-stage AMD at 5 years vs a 28% probability for those taking a placebo. In exudative neovascular AMD, 94.6% of patients receiving monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections experience less than a 15-letter visual acuity loss after 12 months compared with 62.2% receiving sham treatment.

Conclusions and Relevance  The prevalence of AMD is anticipated to increase worldwide to 288 million individuals by 2040. Intravitreally administered anti-VEGF treatment is first-line therapy for exudative neovascular AMD.

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