一种利用年龄相关性眼病研究组（AREDS）研究和临床电子病历的数据驱动型年龄相关性黄斑变性严重程度评分系统。
A Data-driven Age-related Macular Degeneration Severity Scoring System Leveraging the AREDS Studies and Clinical Electronic Medical Records.
作者信息
Lee Cecilia S, Su Yu-Ru, Walker Rod L, Krakauer Chloe, Blazes Marian, Johnson Eric A, Cronkite David, Bowers Will, Hess Chantelle, Arterburn David, Agrón Elvira, Chew Emily Y, Crane Paul K
机构信息
Department of Ophthalmology, University of Washington, Seattle, Washington; The Roger and Angie Karalis Johnson Retina Center, Seattle, Washington.
Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington.
出版信息
Ophthalmology. 2025 Apr 30. doi: 10.1016/j.ophtha.2025.04.026.
PURPOSE
To develop a data-driven severity scoring system for age-related macular degeneration (AMD) that can generate distinct scores for exudative AMD (AMD-W) and nonexudative AMD (AMD-D) and that can be applied to routine clinical features captured in electronic medical record (EMR) data, in which complete data on features included in traditional scoring systems are rare.
DESIGN
Retrospective cohort study with external validation.
PARTICIPANTS
Data from participants in the Age-Related Eye Disease Study (AREDS), AREDS2, and the Eye Adult Changes in Thought (Eye ACT) study.
METHODS
Severity score models were developed for non-exudative ("dry") AMD (AMD-D) and exudative ("wet") AMD (AMD_W) based on confirmatory factor analysis (CFA) of data from AREDS and AREDS2. Models were applied to an independent cohort of the Eye ACT study whose longitudinal ophthalmic clinical data were extracted from an EMR capturing routine care, using natural language processing-based text mining algorithms.
MAIN OUTCOME MEASURES
Trajectories of AMD-D and AMD-W scores in the Eye ACT cohort and relationship with age and the onset of the first anti-VEGF treatment.
RESULTS
In the Eye ACT cohort, AMD-D and AMD-W scores showed a moderately positive correlation (Pearson 0.702, 95% confidence interval, 0.699-0.704). In 4412 eyes from 2248 participants in Eye ACT, which never received anti-VEGF, AMD-D scores increased slightly before the age of 80 years, followed by a steeper increase through the age of 90 years. In 220 eyes of 171 Eye ACT participants, which received anti-VEGF, most showed a pattern of gradually increasing AMD-W scores in the weeks or months before the anti-VEGF treatment.
CONCLUSIONS
The CFA-based scoring system enabled detailed assessments of both non-exudative and exudative severity using features collected in a routine clinical setting with ubiquitous missing data, in which standard AREDS scoring is not possible.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
目的
开发一种数据驱动的年龄相关性黄斑变性（AMD）严重程度评分系统，该系统能够为渗出性AMD（AMD-W）和非渗出性AMD（AMD-D）生成不同的分数，并且可以应用于电子病历（EMR）数据中记录的常规临床特征，而传统评分系统中包含的特征的完整数据很少见。
设计
具有外部验证的回顾性队列研究。
参与者
年龄相关性眼病研究（AREDS）、AREDS2和成人眼部思维变化（Eye ACT）研究参与者的数据。
方法
基于AREDS和AREDS2数据的验证性因子分析（CFA），为非渗出性（“干性”）AMD（AMD-D）和渗出性（“湿性”）AMD（AMD_W）开发严重程度评分模型。使用基于自然语言处理的文本挖掘算法，将模型应用于Eye ACT研究的一个独立队列，该队列的纵向眼科临床数据是从记录常规护理的EMR中提取的。
主要观察指标
Eye ACT队列中AMD-D和AMD-W分数的轨迹以及与年龄和首次抗VEGF治疗开始的关系。
结果
在Eye ACT队列中，AMD-D和AMD-W分数呈中度正相关（Pearson相关系数为0.702，95%置信区间为0.699-0.704）。在Eye ACT研究中2248名从未接受抗VEGF治疗的参与者的4412只眼中，AMD-D分数在80岁之前略有增加，然后在90岁之前急剧增加。在171名接受抗VEGF治疗的Eye ACT参与者的220只眼中，大多数在抗VEGF治疗前的数周或数月内呈现AMD-W分数逐渐增加的模式。
结论
基于CFA的评分系统能够使用在常规临床环境中收集的特征对非渗出性和渗出性严重程度进行详细评估，这些数据普遍存在缺失，无法进行标准的AREDS评分。
财务披露
参考文献之后可能会有专有或商业披露信息。
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