Abstract
Purpose :
To evaluate the significance of both color fundus features and optical coherence tomography (OCT) features and dark adaptation (DA) function in their association with progression to choroidal neovascularization, geographic atrophy and complete retinal epithelium and outer retinal atrophy (cRORA).
Methods :
Participants aged > 50 years with and without age-related macular degeneration (AMD) were evaluated with multimodal imaging. Color fundus photography (CFP) was used to determine AMD severity scores. Structural features were assessed on OCT and CFP. Each study eye underwent DA testing measuring rod intercept time (RIT) at 5o eccentricity superior to the fovea. Multivariable proportional hazards regression was used to determine the association of clinical and demographic covariates to three primary outcomes for progression to (1) late AMD (severity score 9-11), (2) cRORA, and (3) late AMD and/or cRORA. Hazard ratio (HR), 95% confidence intervals (CI) of HR, and p-values are reported for each significant association.
Results :
For the outcome of late AMD, 129 eyes were included. 13 (10.1%) of eyes developed late AMD. RIT (HR=1.11 [CI 1.04-1.19], p=0.002), hyperreflective foci (HRF) (HR=12.42 [CI 2.40-64.26], p=0.003), and retina thickness in the center (HR=1.02 [CI 1.00-1.05], p=0.031), inner nasal (HR=1.05 [CI 1.01-1.09], p=0.015), and inner temporal (HR=0.85 [CI 0.73-0.99], p=0.036) subfields of the Early Treatment Diabetic Retinopathy Study grid were associated with progression to late AMD. In the analysis for cRORA outcome, 16/121 (13.2%) eyes developed cRORA. Drusen area (HR=10.15 [CI 1.30-79.34], p=0.027), HRF (HR=7.03 [CI 2.17-22.85], p=0.001), and RIT (HR=1.08 [CI 1.02-1.14], p=0.006) were associated with progression to cRORA. Of the 121 eyes, 19 (15.7%) progressed to late AMD or cRORA. The regression showed a significant association with drusen area (HR=6.15 [CI 1.27-29.70], p=0.024), RIT (HR=1.08 [CI 1.03-1.141], p=0.002), mean inner nasal retina thickness (HR=1.01 [CI 1.00-1.02], p=0.035), and HRF (HR=3.81 [CI 1.37-10.60], p=0.010).
Conclusions :
Rod intercept time, hyperreflective foci, drusen area, and retinal thickness were all associated with greater progression rates to either late AMD or cRORA. The significance of RIT and HRF for progression in all three models suggests that these variables might further contribute to the understanding and classification of AMD.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.