Major Predictive Factors for Progression of Early to Late Age-Related Macular Degeneration

Abstract

<b><i>Introduction:</i></b> We present a prediction model for progression from early/intermediate to advanced age-related macular degeneration (AMD) within 5.9 years. <b><i>Objectives:</i></b> To evaluate the combined role of genetic, nongenetic, and phenotypic risk factors for conversion from early to late AMD over ≥5 years. <b><i>Methods:</i></b> 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. <b><i>Results and Conclusions:</i></b> During a mean of 5.9 years of follow-up, 22.4% (<i>n</i> = 52) of the patients (<i>n</i> = 232) showed progression to late AMD. The multivariable prediction model included age, <i>CFH</i> 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, <i>p</i> = 0.797). In addition to advanced age and carrying a <i>CFH</i> 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.