June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Evaluating the AREDS grading scale for age-related macular degeneration in AREDS2
Author Affiliations & Notes
  • Susan Vitale
    Div Epidemiol & Clin Applications, National Eye Inst/NIH, Bethesda, MD
  • Traci E Clemons
    Emmes Corporation, Rockville, MD
  • Elvira Agron
    Div Epidemiol & Clin Applications, National Eye Inst/NIH, Bethesda, MD
  • Frederick L Ferris
    Div Epidemiol & Clin Applications, National Eye Inst/NIH, Bethesda, MD
  • Amitha Domalpally
    Fundus Photograph Reading Center, University of Wisconsin, Madison, WI
  • Ronald P Danis
    Fundus Photograph Reading Center, University of Wisconsin, Madison, WI
  • Emily Y Chew
    Div Epidemiol & Clin Applications, National Eye Inst/NIH, Bethesda, MD
  • Footnotes
    Commercial Relationships Susan Vitale, None; Traci Clemons, None; Elvira Agron, None; Frederick Ferris, Bausch & Lomb (P); Amitha Domalpally, None; Ronald Danis, None; Emily Chew, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 3794. doi:
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      Susan Vitale, Traci E Clemons, Elvira Agron, Frederick L Ferris, Amitha Domalpally, Ronald P Danis, Emily Y Chew, ; Evaluating the AREDS grading scale for age-related macular degeneration in AREDS2. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3794.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To compare 5-year rates of development of late age-related macular degeneration (AMD) between the AREDS and AREDS2 studies, using the AREDS severity scale for AMD.

 
Methods
 

The severity scale for AMD is based on stereoscopic color fundus photograph gradings developed by using study data from the AREDS clinical trial, which compared the risk of late AMD for placebo versus high-dose antioxidants and/or zinc. Photos were graded for drusen characteristics (size, area), pigmentary abnormalities (hyper- or hypopigmentation or geographic atrophy (GA)), and signs of neovascular AMD (nvAMD). Risk of development of late AMD (nvAMD, central GA, or treatment for AMD) within 5 years increased with each additional step on the scale in AREDS participants. In AREDS2, participants at high risk of developing late AMD were recruited for a second, separate clinical trial of nutritional supplements for AMD. Stereo color fundus photographs were obtained yearly for AREDS2 participants and graded by masked graders using protocols developed for AREDS. The severity scale was computed for each AREDS2 participant at baseline and 5-year rates of late AMD were computed for each step of the scale, starting at step 4, the minimal AMD severity recruited into AREDS2. One eye per participant was designated as the study eye (free of late AMD) for analyses.

 
Results
 

2719 AREDS2 participants (aged 50-86 y (mean, 72 y), 58% female) were free of late AMD in both eyes at baseline. At baseline, 97.9% of study eyes had drusen area ≥ area of a 125-μm-diameter circle (.0069 disc area), 98.2% had ≥ 1 intermediate-sized druse, and 93.0% had ≥ 1 large druse. At baseline, 56.5% of study eyes had increased pigmentation, 21.8% had depigmentation or noncentral GA, and 59.2% had ≥ 1 type of retinal pigment epithelial abnormality. The rates of progression to late AMD in AREDS and AREDS2 by the AREDS AMD scale are compared in the Figure.<br /> The differences in the rates of progression to late AMD between AREDS and AREDS2 may be explained by the fact that all AREDS2 participants received a form of antioxidant plus zinc, while the AREDS population included two treatment arms that did not include both antioxidants and zinc (AREDS supplements).

 
Conclusions
 

The AREDS severity scale for AMD appears to perform comparably in the AREDS2 data. The scale will be a useful tool for characterizing risk of late AMD.  

 
Comparison of rates of late AMD for AREDS (blue) and AREDS2 (red).
 
Comparison of rates of late AMD for AREDS (blue) and AREDS2 (red).

 
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