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Sarah Thiele, Jennifer Nadal, Maximilian Pfau, Arno Goebel, Monika Fleckenstein, Matthias Schmid, Frank G Holz, Steffen Schmitz-Valckenberg; Characterization and disease progression of intermediate age-related macular degeneration in the prospective, longitudinal natural history ModiAMD Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2329.
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To analyze eyes at high-risk for progression to late-stage AMD over a five year period in the context of a prospective, longitudinal natural history study (ModiAMD).
Ninety-eight eyes with intermediate AMD (AREDS stage 3 or 4) of 98 patients (mean age 73.1 ± 7.1 years, range 51-89 years) were included in the ModiAMD study at baseline. At baseline and annual study visits, best-corrected visual acuity was determined and multimodal imaging was performed according to standardized operating procedures including spectral-domain optical coherence tomography, color fundus photography, fundus-autofluorescence- and infrared-reflection imaging. GA was defined through multimodal criteria (FAF: hypofluorescent area >0.1mm^2 and corresponding ONL thinning and choroidal hypertransmission in SD-OCT) and/or AREDS criteria.
Applying the multimodal criteria, 42 (42.9%) eyes progressed to late-stage AMD after five years: 7 patients after one year, 20 patients after two, 26 after three and 34 after four years. In 25 (59.5%) eyes chorioidal neovascularization (CNV) and in 17 (40.5%) eyes central geographic atrophy (GA) occurred. Risk factors for conversion to both late-forms included hyperpigmentations (p=0.027) and confluent drusen (p=0.04) at baseline. Of the 17 eyes with central GA development, preexisting paracentral GA progressed into the central subfield in 6 eyes, while 11 eyes developed de-novo GA. Yet based on AREDS criteria, only 7 of these 17 eyes would have been recognized as having developed central GA.
These findings are important for a better understanding of conversion rates and high-risk features for development of late-stage AMD. They confirm that morphological biomarkers are of particular prognostic value. Further, the results indicate that multimodal imaging may allow for earlier and more precise detection of vision-related disease manifestation.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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