Comparison of standardized color photography grading and SDOCT volume analysis to predict 2-year progression from intermediate to advanced age-related macular degeneration

Abstract

 

Purpose

 

To compare sensitivity of color fundus photography (CFP) macular surface area grading of drusen and geographic atrophy (GA) with spectral domain optical coherence tomography (SDOCT) volume analysis of drusen and retinal pigment epithelium abnormal thinning (RAT) for predicting progression from intermediate age-related macular degeneration (AMD) to neovascular advanced AMD.

 

Methods

 

Eyes with intermediate AMD were enrolled in the prospective Age-Related Eye Disease Study 2 (AREDS2) Ancillary SDOCT Study. After semi-automated SDOCT segmentation, macular volumes for drusen and RAT were calculated in AMD eyes based on a normative SDOCT database of 115 healthy age-controlled eyes. Same-visit AREDS2 CFP drusen area score grading (scale 0-7) and CFP GA disc area grading were performed in AMD eyes. Each baseline measurement was compared with 2-year outcome of choroidal neovascularization (CNV) by Wilcoxon rank sum test, odds ratio (OR) with 95% confidence interval (CI), and receiver operating characteristic area under the curve (AUC).

 

Results

 

265 intermediate AMD eyes with baseline CFP and SDOCT analysis were included. Of 239 eyes followed to year 2, 30 developed CNV (13%). CNV was associated with greater CFP drusen score (Mean ± standard deviation scores: 6.7 ± 0.6 mm² vs. 6.1 ± 1.1 mm²; p=0.001; OR=2.1, CI=3.8-1.3; AUC=0.64) and greater SDOCT drusen volume (Mean ± standard deviation volumes: 0.17 ± 0.28 mm³ vs. 0.06 ± 0.12 mm³; p<0.001; OR=21.0, CI=229.5-2.7; AUC=0.68). CNV was not associated with baseline CFP GA area (p=0.63) or SDOCT RAT volume (p=0.06).

 

Conclusions

 

CFP drusen area and SDOCT drusen volume measurements had similar ability to predict CNV based on AUC. As a continuous variable, SDOCT drusen volume may be able to stratify eyes within the category of intermediate AMD to predict their risk of progression to CNV.

 

Keywords: 550 imaging/image analysis: clinical • 701 retinal pigment epithelium • 504 drusen