June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Predictive Model for Requirement of Future Anti-VEGF Therapy in Diabetic Eye Disease: The Potential Importance of the Leakage Index on Ultra-widefield Fluorescein Angiography
Author Affiliations & Notes
  • Christopher J. Mugnaini
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Duriye Damla Sevgi
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Jon Whitney
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Alice C. Jiang
    Case Western Reserve University, Cleveland, Ohio, United States
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Ming Hu
    Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States
  • Sunil K. Srivastava
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Jamie Reese
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Justis P Ehlers
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Christopher Mugnaini, None; Duriye Damla Sevgi, None; Jon Whitney, None; Alice Jiang, None; Ming Hu, None; Sunil K. Srivastava, Abbvie (C), Allergan (F), Allergan (C), Eyepoint (F), Eyepoint (C), Eyevensys (F), Eyevensys (C), Gilead (C), Leica (P), Novartis (C), Regeneron (F), Regeneron (C), Santen (F), Zeiss (C); Jamie Reese, None; Justis Ehlers, Adverum (C), Aerpio (F), Aerpio (C), Alcon (F), Alcon (C), Allegro (C), Allergan (F), Allergan (C), Boehringer-Ingelheim (F), Genentech (F), Genentech/Roche (C), Leica (C), Leica (P), Novartis (F), Novartis (C), Regeneron (F), Regeneron (C), Santen (C), Stealth (C), Thrombogenics/Oxurion (F), Thrombogenics/Oxurion (C), Zeiss (C)
  • Footnotes
    Support  RPB Cole Eye Institutional Grant, NIH/NEI K23-EY022947
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2111. doi:
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      Christopher J. Mugnaini, Duriye Damla Sevgi, Jon Whitney, Alice C. Jiang, Ming Hu, Sunil K. Srivastava, Jamie Reese, Justis P Ehlers; Predictive Model for Requirement of Future Anti-VEGF Therapy in Diabetic Eye Disease: The Potential Importance of the Leakage Index on Ultra-widefield Fluorescein Angiography. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2111.

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

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Abstract

Purpose : To identify imaging biomarkers and patient characteristics that predict future need for anti-VEGF therapy in diabetic retinopathy (DR) using an integrative machine learning predictive model.

Methods : Retrospective image analysis study of anti-VEGF naive eyes with DR who underwent ultra-widefield fluorescein angiography (UWFA) and optical coherence tomography (OCT). Quantitative UWFA analysis was performed using a custom semi-automated platform for leakage index (LI), ischemic index, microaneurysm (MA) count and vascular density (VD) parameters (skewness. kurtosis, variance, and zero VD index). OCT scans were reviewed for mean central subfield thickness (CST) and the presence of diabetic macular edema (DME). Two random forest classifiers grown with 1000 trees using 3 randomly sampled features as candidates at each split were created to differentiate eyes that required anti-VEGF within 3 months (including on the day of UWFA) and after 3 months of the imaging visit from the eyes that did not require any anti-VEGF during the follow-up period. Features including age, gender, follow-up time, visual acuity (VA), panretinal LI, macular LI, ischemic index MA count, CST, presence of DME and VD parameters were selected for model testing.

Results : Eyes requiring anti-VEGF within 3 months (n=38) of the UWFA imaging session and eyes requiring anti-VEGF after 3 months (n=34) following the imaging visit were compared to the eyes that did not require any anti-VEGF treatment (n=101), independently. The mean follow-up time was 22 (11- 43) months. The area under the curve (AUC) for the anti-VEGF initiation within 3 months model was 0.93 ± 0.03 with the most important features being VA, CST, macular LI, and total LI (importance: 0.211, 0.197, 0.100 and 0.069 respectively). The AUC for differentiating eyes that required anti-VEGF treatment after 3 months vs eyes that did not require any anti-VEGF treatment was 0.77 ± 0.04 with the four most important features being VA, macular leakage index, total leakage index, and follow-up time (importance: 0.112, 0.112, 0.102 and 0.100 respectively).

Conclusions : A ML predictive model was successful identifying eyes requiring immediate and future anti-VEGF therapy. The most important predictive features in both models included VA and macular LI.

This is a 2021 ARVO Annual Meeting abstract.

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