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Proposal of a simple optical coherence tomography-based scoring system for progression of age-related macular degeneration

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To develop a simple, clinically practical, optical coherence tomography (OCT)-based scoring system for early age-related macular degeneration (AMD) to prognosticate risk for progression to late AMD.

Methods

We retrospectively reviewed OCT images (512 × 128 macular cube, Cirrus) from 138 patients diagnosed of early AMD in at least one eye and follow-up of at least 12 months. For patients with early AMD in both eyes, only the right eye was chosen as the study eye for longitudinal assessment. Scans were graded on four SD-OCT criteria associated with disease progression in previous studies: drusen volume within a central 3-mm circle ≥0.03 mm3, intraretinal hyperreflective foci (HRF), hyporeflective foci (hRF) within a drusenoid lesion (DL), and subretinal drusenoid deposits (SDD). Each criterion was assigned one point. For risk assessment of the study eye, the baseline status of the fellow eye was also considered, and thus these four features were also assessed in the fellow eye. The number of risk factors were summed for both eyes, yielding a total score (TS) of 0 to 8 for each patient. A fellow eye with evident choroidal neovascularization (CNV) or atrophy automatically received 4 points. Scores were then grouped into four categories to facilitate comparative analysis: I. (TS of 0, 1, 2), II. (TS of 3, 4), III. (TS of 5, 6) and IV. (TS of 7, 8). Correlation of baseline category assignment with progression to late AMD (defined as the presence of atrophy or CNV on OCT) by the last follow-up visit was evaluated with logistic regression analysis.

Results

The rate of progression to late AMD was 39.9% (55/138). Progression rates by category (I to IV) were 0, 14.3, 47.5, and 73.3%, respectively. Logistic regression analysis showed risk of progression to late AMD was 3.0 times (95% CI: 1.2–7.9) higher for an eye assigned to category IV than for an eye in category III and 16.4 (95% CI: 4.7–58.8) times higher than for an eye in category II.

Conclusions

A simple scoring system relevant to prognosis for early AMD, and practical for use in a busy clinic, can be developed using SD-OCT criteria alone.

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Authors and Affiliations

  1. Doheny Image Reading Center, Doheny Eye Institute, 1350 San Pablo St., DVRC211, Los Angeles, CA, 90033, USA

    Jianqin Lei, Siva Balasubramanian, Nizar Saleh Abdelfattah, Muneeswar G. Nittala & SriniVas R. Sadda

  2. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Jianqin Lei, Siva Balasubramanian, Nizar Saleh Abdelfattah, Muneeswar G. Nittala & SriniVas R. Sadda

  3. 1st Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Jianqin Lei

Authors
  1. Jianqin Lei
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  2. Siva Balasubramanian
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  3. Nizar Saleh Abdelfattah
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  4. Muneeswar G. Nittala
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  5. SriniVas R. Sadda
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Corresponding author

Correspondence to SriniVas R. Sadda.

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Funding

No funding was received for this research.

Conflict of interest

Jianqin Lei, none; Siva Balasubramanian, none; Nizar Saleh Abdelfattah, none; Muneeswar G. Nittala, none; SriniVas R. Sadda, Carl Zeiss Meditec (F), Optos (F, C), Allergan (F, C), Genentech (C, F), Alcon (C); Novartis (C); Roche (C), Regeneron (C), Bayer (C), Thrombogenics (C), Stemm Cells Inc. (C), Avalanche (C).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This is a retrospective study and for this type of study formal consent is not required.

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Lei, J., Balasubramanian, S., Abdelfattah, N.S. et al. Proposal of a simple optical coherence tomography-based scoring system for progression of age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 255, 1551–1558 (2017). https://doi.org/10.1007/s00417-017-3693-y

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  • DOI: https://doi.org/10.1007/s00417-017-3693-y

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