• Two-Year AMD Progression Predicts Late AMD and Long-Term Visual Loss

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, June 2020

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    Vitale et al. set out to determine whether patients with faster short-term wors­ening of age-related macular degener­ation (AMD) would reach late AMD more quickly. They found that two-year progression along the 9-step Age-Relat­ed Eye Disease Study (AREDS) AMD severity scale correlated with poor clin­ical and visual outcomes by year 7.

    This study focused on a cohort of 3,868 AREDS patients (7,736 eyes) who had at least one eye without late AMD or geographic atrophy (GA) at base­line. Two-year AMD progression was defined as an increase of ≥2 or ≥3 steps on the AMD scale. Year 7 outcomes were neovascular AMD, central GA, any GA, and best-corrected visual acuity (BCVA) loss of ≥2 or ≥3 lines.

    Two-year progression of 2 steps or more occurred in 9% of eyes; pro­gression of at least 3 steps occurred in 3.7%. By year 7, neovascular AMD was present in 6.7% of those eyes, 4.7% had central GA, 10% had any GA, and 37% and 20.9% had a loss in BCVA of ≥2 or ≥3 lines, respectively.

    After adjusting for confounders and stratifying data by baseline AMD score, the authors noted that AMD progres­sion of at least 2 steps in the first two years correlated with neovascular AMD by year 7; hazard ratios (HRs) ranged from 3.6 to 19.4. HRs for development of central GA or any GA ranged from 2.6 to 4.7 and from 1.6 to 16.9, respec­tively. HRs for decreased BCVA ranged from 1.3 to 2.8. The link to poor out­comes was stronger for two-year AMD progression of ≥3 steps than for ≥2 steps, and risk generally was higher for progressing eyes that had lower AMD scores at baseline. For external valida­tion, the authors applied their analyses to a separate cohort of patients drawn from AREDS2; they noted similar pre­dictor-outcome associations.

    Clinical trials of AMD treatments, especially those targeting earlier disease stages, may be stymied by the need for large sample sizes and long follow-up times to account for slow infrequent progression to late AMD. Results of this study suggest that patients free of bilateral late AMD at baseline who have disease progression by year 2 are more likely than nonprogressing patients to have late AMD and visual loss by year 7. Further clinical studies in this at-risk subpopulation may help investigators detect meaningful treatment effects in smaller short-duration studies.

    The original article can be found here.