Predictive value of Preferential Hyperacuity Perimetry in identifying patients at high risk of conversion to neovascular AMD

Abstract

Purpose : Established biomarkers for identifying patients at high risk of conversion from intermediate to neovascular age related macular degeneration (nAMD) have been ineffective as inclusion criteria for prophylactic treatment trials.[KN1] This work studies if the non-exudative alerts generated by a preferential hyperacuity perimetry (PHP) device can be a predictive tool for identifying these patients at high risk of conversion to nAMD.

Methods : ALOFT study was a retrospective analysis of the 10-year visual acuity outcome data of 2123 patients participating in the PHP-based ForseeHome monitoring program [1]. This work includes all eyes that had a ForeseeHome alert, and not immediately diagnosed with nAMD, characterized as non-exudative (NE) alert eyes. All ALOFT eyes are included in the baseline group. The reference group includes eyes from nAMD prophylactic treatment trials PROCON and PREVENT designed to enroll eyes with high risk of conversion. For baseline and NE alert groups status of the fellow eye was also recorded. A Kaplan–Meier (K–M) survival function and log-rank test were used to compare the risk of conversion for different groups.

Results : A total of 953 (29%) of the eyes had a NE alert. For a 12-month period, baseline groups had 3% (fellow iAMD) and 14% (fellow nAMD) probability of conversion compared to NE alert group with 6% (fellow iAMD) and 22% (fellow nAMD). PROCON and PREVENT had 8% and 9% probability of conversion, with all eyes fellow nAMD in these trials. The approximate timing of conversions was reconstructed from the K–M graph (Figure 1). A log-rank test demonstrated significant differences in conversion rates between the NE alert (fellow nAMD) to all other groups (p < 0.05).

Conclusions : Eyes with non-exudative alerts fellow to nAMD eyes were at a significantly higher risk of conversion. These eyes were also at a higher risk with comparable eyes in past nAMD prophylactic trials. Non-exudative alerts are strong predictor for conversion to nAMD and are of importance both for clinical management and potential enrichment of prophylactic trials.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1: Kaplan–Meier estimate of conversion functions for ALOFT study with non-exudative alerts and baseline eyes, PROCON and PREVENT studies. BL = Baseline; NE = non-exudative; iAMD = intermediate dry AMD; nAMD = neovascular AMD