Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
Ophthalmologica. 2020;243(6):444-452. doi: 10.1159/000507196. Epub 2020 Mar 13.
We present a prediction model for progression from early/intermediate to advanced age-related macular degeneration (AMD) within 5.9 years.
To evaluate the combined role of genetic, nongenetic, and phenotypic risk factors for conversion from early to late AMD over ≥5 years.
Baseline phenotypic characteristics were evaluated based on color fundus photography, spectral-domain optical coherence tomography, and infrared images. Genotyping for 36 single-nucleotide polymorphisms as well as systemic lipid and complement measurements were performed. Multivariable backward logistic regression resulted in a final prediction model.
During a mean of 5.9 years of follow-up, 22.4% (n = 52) of the patients (n = 232) showed progression to late AMD. The multivariable prediction model included age, CFH variant rs1061170, pigment abnormalities, drusenoid pigment epithelial detachment (DPED), and hyperreflective foci (HRF). The model showed an area under the curve of 0.969 (95% confidence interval 0.948-0.990) and adequate calibration (Hosmer-Lemeshow test, p = 0.797). In addition to advanced age and carrying a CFH variant, pigment abnormalities, DPED, and HRF are relevant imaging biomarkers for conversion to late AMD. In clinical routine, an intensified monitoring of patients with a high-risk phenotypic profile may be suitable for the early detection of conversion to late AMD.
我们提出了一个预测模型，可以在 5.9 年内预测早期/中期年龄相关性黄斑变性（AMD）进展为晚期 AMD。
评估遗传、非遗传和表型危险因素在≥5 年内从早期 AMD 向晚期 AMD 转化的综合作用。
根据眼底彩色照相、光谱域光学相干断层扫描和红外图像评估基线表型特征。对 36 个单核苷酸多态性进行基因分型，并进行系统脂质和补体测量。多变量向后逻辑回归得出最终预测模型。
在平均 5.9 年的随访中，22.4%（n=52）的患者（n=232）进展为晚期 AMD。多变量预测模型包括年龄、CFH 变体 rs1061170、色素异常、斑状色素上皮脱离（DPED）和高反射焦点（HRF）。该模型的曲线下面积为 0.969（95%置信区间为 0.948-0.990），校准良好（Hosmer-Lemeshow 检验，p=0.797）。除了年龄较大和携带 CFH 变体外，色素异常、DPED 和 HRF 是转化为晚期 AMD 的相关影像学生物标志物。在临床常规中，对具有高风险表型特征的患者进行强化监测可能适合早期发现转化为晚期 AMD。
