Perkins Scott W, Wu Anna K, Singh Rishi P
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Saudi J Ophthalmol. 2022 Oct 14;36(3):315-321. doi: 10.4103/sjopt.sjopt_73_22. eCollection 2022 Jul-Sep.
Patients with neovascular age-related macular degeneration (nAMD) have varying responses to anti-vascular endothelial growth factor injections. Limited early response (LER) after three monthly loading doses is associated with poor long-term vision outcomes. This study predicts LER in nAMD and uses feature importance analysis to explain how baseline variables influence predicted LER risk.
Baseline age, best visual acuity (BVA), central subfield thickness (CST), and baseline and 3 months intraretinal fluid (IRF) and subretinal fluid (SRF) for 286 eyes were collected in a retrospective clinical chart review. At month 3, LER was defined as the presence of fluid, while early response (ER) was the absence thereof. Decision tree classification and feature importance methods determined the influence of baseline age, BVA, CST, IRF, and SRF, on predicted LER risk.
One hundred and sixty-seven eyes were LERs and 119 were ERs. The algorithm achieved area under the curve = 0.66 in predicting LER. Baseline SRF was most important for predicting LER while age, BVA, CST, and IRF were somewhat less important. Nonlinear trends were observed between baseline variables and predicted LER risk. Zones of increased predicted LER risk were identified, including age <74 years, and CST <290 or >350 μm, IRF >750 nL, and SRF >150 nL.
These findings explain baseline variable importance for predicting LER and show SRF to be the most important. The nonlinear impact of baseline variables on predicted risk is shown, increasing understanding of LER and aiding clinicians in assessing personalized LER risk.
新生血管性年龄相关性黄斑变性（nAMD）患者对抗血管内皮生长因子注射的反应各不相同。在接受三个月的负荷剂量注射后出现有限早期反应（LER）与长期视力不佳相关。本研究预测nAMD中的LER，并使用特征重要性分析来解释基线变量如何影响预测的LER风险。
通过回顾性临床病历审查，收集了286只眼睛的基线年龄、最佳视力（BVA）、中心子野厚度（CST）以及基线和3个月时的视网膜内液（IRF）和视网膜下液（SRF）。在第3个月时，LER定义为存在液体，而早期反应（ER）则为不存在液体。决策树分类和特征重要性方法确定了基线年龄、BVA、CST、IRF和SRF对预测的LER风险的影响。
167只眼睛为LER，119只为ER。该算法在预测LER时的曲线下面积 = 0.66。基线SRF对预测LER最为重要，而年龄、BVA、CST和IRF的重要性稍低。观察到基线变量与预测的LER风险之间存在非线性趋势。确定了预测LER风险增加的区域，包括年龄<74岁、CST<290或>350μm、IRF>750 nL和SRF>150 nL。
这些发现解释了基线变量对预测LER的重要性，并表明SRF是最重要的。显示了基线变量对预测风险的非线性影响，增加了对LER的理解，并有助于临床医生评估个性化的LER风险。
