RU2559090C1 - Method for prediction of individual risk of macular dystrophy development - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: past medical history is taken, and the patient is examined and interviewed. Risk factors are assessed and scored. The assessment takes into account patient's age, ethnicity, sex, eye colours, cholesterol level, arterial hypertension, overweight, retinal pathology, smoking, alcohol, visual impairment, straight line distortion, diagnosed macular dystrophy, diabetes mellitus, cataract surgeries, and insolation. A macular dystrophy risk index (MDRI) is calculated as total score of all individual risk factors. If the MDRI is less than 5, the macular dystrophy risk is predicted as negligible. If the MDRI falls within the range of 5 to 20, the low risk is predicted. If the MDRI ranges from 20 to 35, the moderate risk is predicted. The MDRI from 35 to 65 enables predicting the high risk. The MDRI of more than 65 shows the very high macular dystrophy risk.

EFFECT: more objective prediction of the individual risk of macular dystrophy development by the integrated assessment of the objective and subjective risk factors contained in the same index.

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Description

The invention relates to ophthalmology and can be used to form personalized recommendations for identifying the risk of macular degeneration.

Macular degeneration is a common name for a group of diseases in which the retina is affected and central vision is impaired. Maculodystrophy is based on vascular pathology and central retinal ischemia, which is responsible for central vision. Statistics show that about 80% of the population have various manifestations of macular degeneration, and the incidence of macular degeneration in Russia is on average about 15 cases per 1000 population. Since the etiopathogenetic mechanisms of the development of macular degeneration remain unknown, and there is no effective treatment, early detection of the risk of macular degeneration is of practical importance. For this purpose, tools for predicting a personified risk of developing macular degeneration are needed.

A simplified clinical scale for calculating the five-year risk of developing advanced macular degeneration (Ferris FL A simplified severity scale for age-related macular degeneration: AREDS report number 18 / FL Ferris, MD Davis, T.E. Clemons, LY Lee, EY Chew , AS Lindblad, RC Milton, SB Bressler, R. Klein; Age-Related Eye Disease Study (AREDS) Research Group // Archives of ophthalmology. 2005. Vol. 123. No. 11. PP. 1570-1574.), In accordance with which one or more large drusen or any violation of the retinal pigment epithelium add one risk factor, the risk factors of both eyes are transferred to a five-level scale (0-4) according to the rule: the absence of large bonds and medium-sized drusen in both eyes - 1 risk factor; late stage of macular degeneration in 1 eye - 2 risk factors, large drusen and hypo / hyperpigmentation - 4 risk factors; and the five-year risk of developing the late stage of macular degeneration is assessed on a scale of: 0 risk factors - 0.5% in at least 1 eye; 1 factor - 3%; 2 factors - 12%; 3 factors - 25%; 4 factors - 50%. The disadvantage of this solution is that it focuses on riskometry of the late stages of macular degeneration and the inability to take into account risk factors associated with lifestyle, subjective manifestations of macular degeneration and a patient's history.

The technical task of the invention is the provision of prediction of a personified risk of macular degeneration.

The solution to the technical problem is achieved by the fact that the method for predicting a personified risk of developing macular degeneration includes determining, according to the anamnesis, the results of examination and questioning of the patient, risk factors that correspond to the following particular risk assessments (ƒ _i ):

age (ƒ ₁ ) equal to “0” if less than 35 years old, “1” if from 35 to 45 years old, “2” if from 45 to 55 years old, “3” if from 55 to 60 years old, “ 4 "if from 60 to 65 years old," 5 "if more than 65 years old;

race (ƒ ₂ ) equal to “5” if European and “0” if not European;

gender (ƒ ₃ ), equal to "5" if female and "0" if male;

eye color (ƒ ₄ ), equal to “0” if black, “2” if dark and “5” if light;

blood cholesterol (ƒ ₅ ), equal to "0" if normal, "1" if there is no information, "3" if elevated, "5" if high;

arterial hypertension (ƒ ₆ ), equal to "0" if absent, "3" if the first type is present, "5" if the second type is present;

overweight (ƒ ₇ ), equal to "0" if absent, "3" if present, "5" if the diagnosis is "obesity";

retinal pathology (ƒ ₈ ), equal to “0” if not available, “3” if there is no information, “30” if present;

smoking (ƒ ₉ ), equal to “0” if you do not smoke and never smoked, “1” if you stopped smoking more than two years ago, “3” if you stopped smoking less than two years ago, “4” if you smoke and smoking experience less than 5 years, “5” if smoking and smoking experience more than 5 years;

alcohol (ƒ ₁₀ ), equal to “0” if he doesn’t drink and didn’t drink alcohol, “1” if he drinks alcohol “on holidays”, “3” if he previously abused alcohol, “4” if he regularly drinks alcohol, “ 5 "if he is abusing alcohol;

decrease in visual acuity over the past year (ƒ ₁₁ ), equal to “0” if it does not note, “1” if it marks in one eye, “10” if it marks in both eyes;

distortion of straight lines (ƒ ₁₂ ) with a private rating equal to "0" if not, "10" if there is;

close relatives (in a straight line) with a diagnosis of Macular Dystrophy (ƒ ₁₃ ), equal to "0" if not, "2" if there is no information, "10" if there is,

diagnosis of diabetes mellitus (ƒ ₁₄ ), equal to “0”, if not, “20”, if 1 type, “10”, if 2 types,

cataract surgery (ƒ ₁₅ ), equal to "0" if not, "10" if there was;

insolation - sunbathing, visiting the solarium (ƒ ₁₆ ), equal to “0”, if rare, “3”, if periodically, “5”, if often,

, и при величине ИРМ менее 5 риск развития макулодистрофии прогнозируют как незначительный; при величине ИРМ от 5 до 20 - как малый, при величине ИРМ от 20 до 35 - как умеренный, при величине ИРМ от 35 до 65 - как высокий и при величине ИРМ более 65 - как очень высокий.with the subsequent calculation of the risk index for the development of macular degeneration (IRM) as the sum of private estimates for all risk factors

, and with an IRM value of less than 5, the risk of developing macular degeneration is predicted to be insignificant; with an IRM value of 5 to 20 - as small, with an IRM value of 20 to 35 - as moderate, with an IRM value of 35 to 65 - as high, and with an IRM value of more than 65 - as very high.

The technical result provided by the given set of features is to increase the objectivity of predicting a personified risk of developing macular degeneration due to aggregation of objective and subjective risk factors in one index.

Implementation of the developed method for predicting a personified risk of macular degeneration is that:

1) according to the anamnesis, the results of the examination and questioning of the patient, particular estimates are determined for each of the seventeen considered risk factors:

- age (factor with a private score of ƒ ₁ ) is determined by personal data, assigning a private score of a factor of ƒ _{1 is} assigned a value equal to: “0” if less than 35 years old, “1” if from 35 to 45 years old, “2”, if from 45 to 55 years old, “3” if from 55 to 60 years old, “4” if from 60 to 65 years old, “5” if more than 65 years old;

- race (factor with a private rating of ƒ ₂ ) is determined on the basis of characteristic visual external characteristics, assigning a particular rating of factor ƒ _{2 a} value equal to: “5” if European or “0” if not European;

- gender (factor with a private score of ƒ ₃ ), on the basis of which a private score of factor ƒ _{3 is} assigned a value equal to: “5” if female and “0” if male;

- eye color (factor with a partial rating of ƒ ₄ ), according to the visual impression, determine the natural color of the eyes, on the basis of which a partial rating of factor ƒ _{4 is} assigned a value equal to: “0” if black, “2” if dark and “5” if light;

- the level of blood cholesterol (factor with a private score ƒ ₅ ) is determined by the results of a fasting blood test or take into account the results of a blood test for cholesterol performed no later than six months before the risk is determined, assigning a private assessment of factor ƒ _{4 a} value equal to: "0" if the cholesterol level is interpreted as normal, “1” if there is no information about the level of cholesterol, “3” if the level of cholesterol is interpreted as “elevated”, “5” if the level of cholesterol is interpreted as “high”;

- arterial hypertension (factor with a private score of ƒ ₆ ) is determined according to the history or survey (questionnaire), assigning a private score of 5

factor ƒ _{6, a} value equal to: “0” if there is no arterial hypertension, “3” if there is arterial hypertension of the first type, “5” if there is arterial hypertension of the second type;

- overweight (factor with a private score of ƒ ₇ ) is determined on the basis of body mass index (BMI, kg / m ² ), calculated on the basis of growth (h, m) and body weight (m, kg) as BMI = m / h ² by assigning to the private assessment of factor ƒ _{7 a} value equal to: “0” if there is no excess weight (BMI does not exceed 25), “3” if there is excess weight (BMI is in the range from 25 to 30), “5” if the diagnosis of obesity (BMI exceeds 30);

- retinal pathology (factor with a private score of ƒ ₈ ) is determined by the results of an ophthalmological examination performed using an ophthalmoscopy, fundus camera examination, optical coherence tomography of the retina, or the results of an analysis of such an examination performed no later than six months before the risk determination are taken into account , assigning to a private assessment of factor ƒ _{8 a} value equal to: “0” if not available, “3” if there is no information, “30” if present;

- smoking (factor with a private rating of ƒ ₉ ) is determined by the results of a survey (questionnaire), assigning to a private assessment of factor ƒ _{9 a} value equal to: “0” if you don’t smoke and never smoked, “1” if you stopped smoking for more than two years ago, “3” if you stopped smoking less than two years ago, “4” if you smoke and smoking experience less than 5 years, “5” if you smoke and smoking experience more than 5 years;

- alcohol (factor with a private rating of ƒ ₁₀ ), determined by the results of a survey (questionnaire), assigning a private assessment of factor ƒ _{10 a} value equal to: "0" if you do not drink and did not drink alcohol, "1" if you drink alcohol "by holidays "," 3 "if you have previously abused alcohol," 4 "if you regularly drink alcohol," 5 "if you abuse alcohol;

- decrease in visual acuity for the last year (factor with a private rating of ƒ ₁₁ ) is determined by the results of a survey (questionnaire), assigning a private assessment of factor ƒ _{11 a} value equal to: “0” if the subject (respondent) does not notice a decrease in visual acuity for the last year , “1” if the subject (respondent) notes a decrease in visual acuity in the last year in one eye, “10” if the subject (respondent) notes a decrease in visual acuity in the last year in both eyes);

- the distortion of straight lines (factor with a private rating of ƒ ₁₂ ) is determined by the results of a survey (questionnaire), assigning a private assessment of factor ƒ _{12 a} value equal to: “0” if the subject (respondent) does not notice distortions of straight lines, “10” if the subject (respondent) notes the distortion of straight lines;

- close relatives (in a straight line) with a diagnosis of Macular Dystrophy (factor with a private rating of ƒ ₁₃ ) are determined according to the medical history or survey (questionnaire), assigning to the private assessment of factor ƒ _{13 a} value equal to: “0”, if there are no such relatives, “2” if there is no information about such relatives or the subject (respondent) finds it difficult to answer, “10” if the subject (respondent) has such relatives,

- the diagnosis of diabetes mellitus (factor with a private score of ƒ ₁₄ ) is determined according to the history or survey (questionnaire), assigning a private assessment of factor ƒ _{14 a} value equal to: "0" if there is no diagnosis of diabetes mellitus, "20", if the diagnosis is Type 1 Diabetes, 10, if the diagnosis is Type 2 Diabetes,

- cataract surgery (factor with a private score of ƒ ₁₅ ), determined according to the history or survey (questionnaire), assigning a private score of factor ƒ _{15 a} value equal to: "0" if there was no such operation, "10" if such the operation was

- insolation (sunbathing, visiting the solarium) (factor with a private score of ƒ ₁₆ ), is determined according to the medical history or survey (questionnaire), assigning to the private score of factor ƒ _{16 a} value equal to: “0” if sunbathing (sunbathing in the sun) ) or a visit to the solarium occurs 7

rarely, "3" if sunbathing (sunbathing) or a visit to the solarium occurs periodically, "5" if sunbathing (sunbathing) or visiting a solarium occurs frequently.

2) received private estimates for each of the seventeen

;considered risk factors, summing them up, are combined into a risk index for the development of macular degeneration (IRM, conventional units)

;

3) according to the value of IRM, the risk of developing macular degeneration is predicted to be insignificant (IRM less than 5); small (IRM from 5 to 20), moderate (IRM from 20 to 35), high (IRM from 35 to 65) and very high (IRM more than 65).

Particular estimates for each of the seventeen considered risk factors are conveniently entered in the table — the examination protocol (table 1).

Examples of the implementation of the developed method.

Example 1. Patient A., 54 years. Complaints of discomfort in the eyes, blurred vision, four months ago underwent inpatient treatment for myocardial infarction. An ophthalmological examination was carried out, including visual acuity, ophthalmoscopy, a fundus camera examination, and optical coherence tomography of the retina. Using questionnaires and anamnesis data, we obtained partial estimates of risk factors for the development of macular degeneration (Table 2), on the basis of which the risk index for the development of macular degeneration IRM = 2 + 5 + 0 + 2 + 3 + 3 + 0 + 0 + 3 + 1 + 7 + was calculated 0 + 0 + 0 + 0 + 0 = 26. This value corresponds to the predicted moderate risk of macular degeneration. The patient was given personalized recommendations to reduce the risk (the need to lower cholesterol, correct hypertension, include foods containing vitamins A and E in the diet) and a second ophthalmological examination was prescribed after 6 months.

Example 2. Patient A-on, 53 years old. Ophthalmologist examination as part of a routine medical examination. An ophthalmological examination was carried out, including visual acuity, ophthalmoscopy, a fundus camera examination, and optical coherence tomography of the retina. Using questionnaires and anamnesis data, we obtained partial estimates of risk factors for the development of macular degeneration (Table 3), based on which the risk index for the development of macular degeneration was calculated IRM = 2 + 5 + 5 + 0 + 1 + 3 + 3 + 0 + 0 + 0 + 0 + 0 + 10 + 0 + 10 + 3 = 42. This value corresponds to the predicted high risk of macular degeneration. The patient was given personalized recommendations to reduce the risk (the need to control cholesterol, correct hypertension, include foods containing vitamins A and E in the diet, exclude insolation) and a second ophthalmologic examination was prescribed after 3 months.

Validation of the proposed method was carried out on a group of 1048 patients in an ophthalmological clinic. The patients underwent an ophthalmological examination, including visual acuity examination, ophthalmoscopy, fundus camera examination, optical coherence tomography of the retina, according to which qualified ophthalmologists made a conclusion about macular degeneration. At the same time, risk factors were determined for the same patients and the risk index for the development of macular degeneration was calculated.

In the group with a slight risk of developing macular degeneration, there were 23 patients - all of them were diagnosed with "macular degeneration is absent."

The group with a low risk of developing macular degeneration included 128 patients, 91 were diagnosed with “macular degeneration is absent” and 37 were diagnosed as “early stage of macular degeneration”.

The group with a moderate risk of developing macular degeneration included 227 patients: 2 were diagnosed as “macular degeneration is absent”, 201 - “early stage of macular degeneration” and 24 - “intermediate stage of macular degeneration”.

The group with a high risk of developing macular degeneration included 528 patients: 9 were diagnosed with an early stage of macular degeneration, 420 with an intermediate stage of macular degeneration, and 99 with a pronounced stage of macular degeneration.

142 patients were included in the group with a very high risk of developing macular degeneration: 14 were diagnosed with an intermediate stage of macular degeneration and 128 with a pronounced stage of macular degeneration.

The same patients were similarly examined 9-17 months after the examination.

In the group with a slight risk of developing macular degeneration: 22 patients were diagnosed with "macular degeneration", and 1 - "early stage of macular degeneration."

In the group with a low risk of developing macular degeneration: 95 were diagnosed with "macular degeneration is absent" and 33 - "early stage of macular degeneration".

In the group with a moderate risk of developing macular degeneration: 1 was diagnosed as “macular degeneration is absent”, 196 - “early stage of macular degeneration” and 32 - “intermediate stage of macular degeneration”.

In the group with a high risk of developing macular degeneration: 6 were diagnosed with an “early stage of macular degeneration”, 403 - “intermediate stage of macular degeneration” and 119 - “severe macular degeneration”.

In the group with a very high risk of developing macular degeneration: 10 were diagnosed with an intermediate stage of macular degeneration and 132 with a pronounced stage of macular degeneration.

The results obtained indicate the validity of the developed method and the feasibility of its use in practical ophthalmology and in scientific research.

Thus, the claimed invention provides objective prediction of a personified risk of macular degeneration.

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Claims (1)

A method for predicting a personified risk of developing macular degeneration, including determining, according to the anamnesis, the results of examination and questioning of a patient, risk factors that correspond to the following particular risk assessments (ƒ _i ): age (ƒ ₁ ) equal to “0” if less than 35 years old, “1 "If from 35 to 45 years old," 2 "if from 45 to 55 years old," 3 "if from 55 to 60 years old," 4 "if from 60 to 65 years old," 5 "if more than 65 years old ; race (ƒ ₂ ), equal to "5" if European, and "0" if not European; gender (ƒ ₃ ), equal to "5" if female, and "0" if male; eye color (ƒ ₄ ), equal to "0" if black, "2" if dark, and "5" if light; blood cholesterol (ƒ ₅ ), equal to "0" if normal, "1" if there is no information, "3" if elevated, "5" if high; arterial hypertension (ƒ ₆ ), equal to "0" if absent, "3" if the first type is present, "5" if the second type is present; overweight (ƒ ₇ ), equal to "0" if absent, "3" if present, "5" if the diagnosis is "obesity"; retinal pathology (ƒ ₈ ), equal to “0” if not available, “3” if there is no information, “30” if present; smoking (ƒ ₉ ), equal to “0” if you do not smoke and never smoked, “1” if you stopped smoking more than two years ago, “3” if you stopped smoking less than two years ago, “4” if you smoke and smoking experience less than 5 years, “5” if smoking and smoking experience more than 5 years; alcohol (ƒ ₁₀ ), equal to “0” if he doesn’t drink and didn’t drink alcohol, “1” if he drinks alcohol “on holidays”, “3” if he previously abused alcohol, “4” if he regularly drinks alcohol, “ 5 "if he is abusing alcohol; decrease in visual acuity over the past year (ƒ ₁₁ ), equal to “0” if it does not note, “1” if it marks in one eye, “10” if it marks in both eyes; distortion of straight lines (ƒ ₁₂ ) with a private rating equal to "0" if not, "10" if there is; close relatives in a straight line with a diagnosis of macular degeneration (ƒ ₁₃ ), equal to "0" if not, "2" if there is no information, "10" if there is; the diagnosis of diabetes mellitus (ƒ ₁₄ ), equal to "0", if not, "20" if 1 type, "10" if 2 types; cataract surgery (ƒ ₁₅ ), equal to "0" if not, "10" if there was; insolation - sunbathing, visiting a solarium (ƒ ₁₆ ), equal to “0”, if rare, “3”, if periodically, “5”, if often, with subsequent calculation of the risk index for the development of macular degeneration (IRM) as the sum of private estimates for all risk factors

, and with an IRM value of less than 5, the risk of developing macular degeneration is predicted to be insignificant, with an IRM value of 5 to 20 - as small, with an IRM value of 20 to 35 - as moderate, with an IRM value of 35 to 65 - as high and with an IRM value over 65 - as very high.