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Susan Vitale, Elvira Agron, Traci E Clemons, Amitha Domalpally, Ronald P Danis, Tiarnan D L Keenan, Emily Y Chew; Association of short-term progression in AMD score with risk of development of late AMD and vision loss in the AREDS2 study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):52.
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Short-term progression (STP) in age-related macular degeneration (AMD) score was associated with long-term increased risk of late AMD and vision loss in the Age-Related Eye Disease Study (AREDS). We examined whether the same risk was associated with STPs in the AREDS2.
The AREDS2 clinical trial (2006-2012) showed that lutein/zeaxanthin was a safe, effective substitute for beta-carotene in the original AREDS nutritional supplement formulation. Masked readers (Univ. of Wisconsin) graded baseline and annual fundus photographs to assign the AREDS AMD score (scores 1-9 depending on level of drusen area and pigment changes) for each eye. Late AMD was defined as 1) photographic grading of neovascular (NV) AMD or documentation of treatment of NV; 2) central geographic atrophy (CGA); or 3) any GA. Visual acuity (VA) outcomes included ≥2-line VA loss (VA2L) and ≥3-line VA loss (VA3L). STPs were defined as ≥2-step or ≥3-step increases in AMD score between baseline and year 2. STPs were used to predict risk of NV, CGA, any GA, VA2L, and VA3L over a 3-year period (from year 2 through year 5 of the AREDS2 study). Proportional hazards regression was used to estimate hazard ratios (HRs), adjusting for demographics and correlation between eyes.
3633 participants (5919 eyes) were free of late AMD at baseline and year 1 (56% female, 96% white, mean age 72.2 y, mean baseline VA 79.8 letters (20/25)). 12.7% had ≥2-step STP and 3.9% had ≥3-step STP. From years 2 through 5, 12.7%, 7.3%, 15.3%, 27.2%, and 15.6% of eyes developed NV, CGA, any GA, VA2L, and VA3L, respectively. Adjusted HRs associated with a ≥2-step STP were 3.2 (95% CI, 2.6-3.8), 6.8 (5.4-8.6), 6.8 (5.6-8.2), 1.4(1.2 -1.6), and 1.6 (1.3-2.0) for NV, CGA, any GA, VA2L, and VA3L, respectively. Adjusted HRs associated with a ≥3-step STP were 7.9 (6.1-10.4), 6.6 (4.7-9.3), 4.2 (3.2-5.6), 1.8 (1.5-2.3), and 2.4 (1.8-3.2), respectively.
≥2 or ≥3-step increases in AMD score from baseline to year 2 significantly increased risk of late AMD and vision loss even after adjustment for baseline AMD score and demographics. These results confirm our earlier findings about the prognostic significance of STPs in the AREDS study. The AREDS AMD scale may be a useful tool to identify eyes at higher risk of late AMD and vision loss. Predictions of late AMD risk might be improved by considering short-term progressions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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