Abstract
Purpose :
To update the Age-Related Eye Disease Study (AREDS) Simplified Severity Scale for 5-year risks of progression to late age-related macular degeneration (AMD), by (i) updating the late AMD definition to include non-central geographic atrophy (GA), (ii) incorporating reticular pseudodrusen (RPD), and (iii) performing external validation on AREDS2.
Methods :
The study populations comprised participants with no late AMD (defined as neovascular AMD or any GA) in either eye at baseline in AREDS (n=2,719 participants) and AREDS2 (n=1,658 participants). Five-year rates of progression to late AMD were calculated according to levels 0-4 on the Simplified Severity Scale, following two updates: (i) non-central GA was considered part of the outcome rather than a risk feature, and (ii) the scale was separated by baseline RPD status (determined by validated deep learning grading of color fundus photographs).
Results :
In AREDS, following the first scale update, the 5-year rates of progression to late AMD for levels 0-4, respectively, were 0.3%, 4.5%, 12.9%, 32.2%, and 55.6%. Following both updates, the proportion progressing to late AMD by 5 years was 8.4% in participants without RPD and 40.6% in those with RPD. As the final Simplified Severity Scale (Figure), the 5-year progression rates for levels 0-4, respectively, were 0.3%, 4.3%, 11.6%, 26.7%, and 50.0%, for participants without RPD, and 2.8%, 8.0%, 29.0%, 58.7%, and 72.2%, for those with RPD. In external validation on AREDS2, for levels 2-4, the progression rates were similar, at 15.3%, 30.4%, and 45.7% (RPD absent) and 27.3%, 47.9%, and 73.0% (RPD present), respectively.
Conclusions :
The AREDS AMD Simplified Severity Scale has been modernized with two important updates. The new scale for individuals without RPD has 5-year progression rates of ~0.5%, 4%, 12%, ~25%, and 50%. These are very similar to the rates on the original scale. The new scale for individuals with RPD has 5-year progression rates of 3%, 8%, ~30%, ~60%, and ~70%, i.e., approximately double for most levels. This scale fits modern definitions of late AMD, has increased prognostic accuracy, appears generalizable between study populations, but remains simple for broad risk categorization.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.