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Using the Rate of Global and Pointwise Microperimetry Change to Predict Structural Conversion in Intermediate
Jeremy C K Tan1,2,3, Giovanni Montesano1,4, Charlotte Behning5
1Optometry and Visual Sciences, City St George's, University of London, London, UK.
Purpose:
Studies evaluating functional change in age-related macular degeneration (AMD) using microperimetry often measure the difference in global mean sensitivity at interval time points versus baseline. We evaluate the rate of global and pointwise microperimetry change in intermediate AMD (iAMD) in the multicenter MACUSTAR (Registration NCT03349801) study and assess their prognostic value in structural conversion to late-stage AMD.
Design:
Prospective study.
Subjects:
Four hundred forty-seven subjects with iAMD (Beckman classification) from 20 European sites.
Methods:
Subjects that underwent mesopic microperimetry on ≥3 follow-up visits were included. Two methods of assessing functional progression were evaluated: (1) global mean sensitivity regression and (2) pointwise sensitivity regression at fastest progressing N number of locations (N from 1 to 10). Rates of microperimetry progression were then evaluated in an initial series of visits prior to structural conversion to late-stage AMD.
Main Outcome Measures:
Area under the receiving operating characteristic (AUC) curves and Cox proportional hazard models were used to assess risk of structural conversion based on rate of functional progression.
Results:
The mean age of subjects was 72 (standard deviation 7) years. The median number of visits and duration of follow-up was 6 visits and 3 years, respectively. Structural conversion to late-stage AMD was observed in 80 (17.9%) eyes. In the visits prior to conversion, there was a greater rate of global mean sensitivity loss in eyes that eventually developed late-stage AMD compared with those that did not (-1.05 vs. -0.30 decibels/year, P < 0.001). The AUC for classifying structural conversion versus no conversion was 0.72 for global sensitivity progression and 0.75-0.76 for between 1 and 10 fastest progressing N pointwise locations. The rate of global (hazard ratio 1.7, confidence interval [CI] 1.4-2.0) and pointwise (hazard ratio 1.2, CI 1.2-1.3) microperimetry progression in the initial series of visits was significantly associated with structural conversion (P < 0.0001).
Conclusions:
In the analysis of longitudinal microperimetry data from the MACUSTAR study, the rate of global and pointwise sensitivity change was significantly greater and strongly prognostic of eyes that developed structural conversion. Our findings support use of these trend-based pointwise analysis methods in assessing functional progression in iAMD.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Insights
The rate of vision loss in intermediate age-related macular degeneration (iAMD) predicts progression to late-stage AMD. Faster functional decline, measured by microperimetry, indicates a higher risk of developing advanced disease.
Area of Science:
- Ophthalmology
- Medical Research
- Vision Science
Background:
- Age-related macular degeneration (AMD) affects central vision, with intermediate AMD (iAMD) being a precursor stage.
- Functional decline in iAMD is typically assessed by microperimetry, measuring visual sensitivity.
- Predicting conversion to late-stage AMD is crucial for timely intervention.
Purpose of the Study:
- To evaluate the rate of global and pointwise microperimetry changes in iAMD patients.
- To assess the prognostic value of these functional changes for conversion to late-stage AMD.
Main Methods:
- Analysis of longitudinal microperimetry data from 447 iAMD subjects in the MACUSTAR study.
- Assessment of global mean sensitivity regression and pointwise sensitivity regression.
- Evaluation of progression rates prior to structural conversion to late-stage AMD.
Main Results:
- Eyes that converted to late-stage AMD showed a significantly greater rate of global mean sensitivity loss (-1.05 dB/year vs. -0.30 dB/year).
- Both global and pointwise microperimetry progression rates were significantly associated with structural conversion (P < 0.0001).
- Area Under the Curve (AUC) values for predicting conversion ranged from 0.72 to 0.76.
Conclusions:
- The rate of functional decline, both globally and pointwise, is a strong predictor of structural conversion in iAMD.
- Trend-based pointwise analysis methods are valuable for assessing functional progression in iAMD.
- These findings support the use of microperimetry trends for monitoring iAMD progression.
