Vision Function in Early to Intermediate AMD: Progression to Advanced AMD

Purpose : To provide preliminary follow-up findings of a longitudinal study to determine whether non-standard vision function tests can predict disease progression in people with early (E) and intermediate (I) age-related macular degeneration (AMD). All enrolled participants had good high contrast acuity (better than 20/40 [≤0.30 logMAR]) at baseline (BL).

Methods : BL participants (N=124) were tested monocularly with best correction on a test battery described previously (Lott, et al, ARVO 2016). AMD status was confirmed by dilated eye exam and fundus photos, and each eye was categorized as Control (C; no drusen, or small drusen only), E (medium drusen only), or I (large drusen and/or AMD pigment abnormalities)1 Participants were called annually to minimize loss to follow-up and to determine whether any had progressed to advanced AMD (neovascularization [NV] or geographic atrophy [GA]). Progression was confirmed using dilated eye exam and fundus photos. General estimating equations (GEE) logistic regression analysis (STATA 13.1) was used to assess the association between BL vision function measures and progression to advanced AMD, while taking into account the correlation between the two eyes.

Results : Seven eyes (of 6 participants) progressed to advanced AMD (6 NV, 1 GA) since BL (mean progression time = 2.25 years [SD=0.98, range 1.0-3.8 years]). All eyes that converted were in the highest risk category at BL (i.e. multiple central large drusen with pigment abnormalities in both eyes). In GEE logistic regression models, only shape discrimination hyperacuity (SDH)2 (OR=3.30, CI=1.14-9.50) and desaturated D-15 color confusion score (DesatCCS)3 (OR=1.86, CI=1.03-3.39) were significant predictors of progression to advanced AMD.

Conclusions : Preliminary data from this longitudinal study support the hypothesis that results of non-standard vision function tests will aid the prediction of advanced AMD progression. SDH and DesatCCS both predict AMD progression to the advanced form. Though contrast sensitivity distinguished among AMD severity grades at BL (Lott et al, ARVO 2016), it was not a significant predictor of progression to advanced AMD.

References: 1 Ferris, et al. Ophthalmol. 2013; 120: 844-51; 2Wang et al. IOVS, 2013; 54: 5497-504; 3Adams & Haegerstrom-Portnoy. Color deficiency. In: Amos JF, ed. Diagnosis and Management in Vision Care. Boston, MA: Butterworths; 1987:671-713

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.