RT - Article
SR - Electronic
T1 - Macular Atrophic versus Subretinal Proliferative Changes in Myopic and Age-Related Macular Degeneration
JF - OPHTHALMOLOGY SCIENCE
SP - 2026-05-23
DO - 10.1016/j.xops.2025.100885
A1 - Jonas, J.B., 
A1 - Jonas, R.A., 
A1 - Bikbov, M.M., 
A1 - Kazakbaeva, G.M., 
A1 - Wan, Ya.X., 
A1 - Nangia, V., 
A1 - Panda-Jonas, S., 
YR - 2025
UL - https://repo.bashgmu.ru/publication/5400
AB - Objective: To assess the prevalences of subfoveal retinal pigment epithelium (RPE) loss versus subfoveal tissue
proliferation as causes of vision loss in patients with late-stage age-related macular degeneration (AMD) or myopic
macular atrophy.
Design: Population-based studies conducted in Russia, China, and India and histological examination of
enucleated human globes.
Participants: The Russian Ural Eye and Medical Study (n = 5899 participants; age: ≥40 years), Ural Very Old
Study (n = 1526; age: 85+ years), Beijing Eye Study (n = 3468; age: ≥40 years), and Central India Eye and Medical
Study (n = 4711) were conducted in rural and urban regions in Bashkortostan/Russia, Beijing/China, and Nagpur/India,
respectively. The histological study part included human eyes enucleated because of reasons like malignant melanomas, or were post mortem enucleated.
Methods: The participants underwent a series of general medical and ophthalmological examinations including
OCT of the macula. In the histological study part, the enucleated globes were histomorphometrically examined.
Main Outcome Measures: Presence of RPE loss and of subretinal proliferations.
Results: In all 4 population-based studies combined, late-stage AMD and myopic macular atrophy were detected
in 291 eyes and 46 eyes, respectively. Retinal pigment epithelium cell loss was dominant in 136 (94%) out of 145 eyes
with geographic atrophy and in 35 (76%) out of 46 eyes with myopic macular atrophy, whereas subretinal proliferations
were predominantly present in 127 (87%) out of 146 eyes with neovascular AMD. Among all 337 eyes with late AMD or
myopic macular atrophy, RPE loss was the main cause for vision loss in 190 (56%) eyes and subretinal proliferations in
147 (44%) eyes, with no significant difference (P > 0.05) between the study cohorts. In the histological specimen,
subretinal proliferations included melanin-bearing cells in contact with a periodic acid—Schiff-positive membrane,
resembling RPE cells.
Conclusions: Subretinal proliferations in the foveal region were the main reason for central visual acuity loss in
44% of all eyes with late AMD or myopic macular atrophy in 4 population-based studies. Subretinal foveal RPE cell
proliferation and RPE loss are roughly equally important as a cause of vision loss in AMD and myopic macular atrophy.