Quantitative SD-OCT Imaging Biomarkers as Indicators of Age-Related Macular Degeneration Progression

PURPOSE: We developed a statistical model based on quantitative characteristics of drusen to estimate the likelihood of conversion from early and intermediate age-related macular degeneration (AMD) to its advanced exudative form (AMD progression) in the short term (less than 5 years), a crucial task to enable early intervention and improve outcomes. METHODS: Image features of drusen quantifying their number, morphology, and reflectivity properties, as well as the longitudinal evolution in these characteristics, were automatically extracted from 2146 spectral-domain optical coherence tomography (SD-OCT) scans of 330 AMD eyes in 244 patients collected over a period of 5 years, with 36 eyes showing progression during clinical follow-up. We developed and evaluated a statistical model to predict the likelihood of progression at predetermined times using clinical and image features as predictors. RESULTS: Area, volume, height, and reflectivity of drusen were informative features distinguishing between progressing and nonprogressing cases. Discerning progression at follow-up (mean, 6.16 months) resulted in a mean area under the receiver operating characteristic curve (AUC) of 0.74 (95% confidence interval [CI], 0.58, 0.85). The maximum predictive performance was observed at 11 months after a patient's first early AMD diagnosis, with mean AUC 0.92 (95% CI, 0.83, 0.98). Those eyes predicted to progress showed a much higher progression rate than those predicted not to progress at any given time from the initial visit. CONCLUSIONS: Our results demonstrate the potential ability of our model to identify those AMD patients at risk of progressing to exudative AMD from an early or intermediate stage.