Major predictive factors for progression of early to late age-related macular degeneration.

INTRODUCTION: In this study we present a prediction model for progression from early/intermediate to advanced age-related macular degeneration within 5.9 years. OBJECTIVES: To evaluate the combined role of genetic, non-genetic and phenotypic risk factors for conversion from early to late age-related macular degeneration (AMD) over five or more years. METHODS: Baseline phenotypic characteristics were evaluated based on color fundus photography, spectral-domain optical coherence tomography and infrared images. Genotyping for 36 single nucleotide polymorphisms and systemic lipid and complement measurements were performed. Multivariable backward logistic regression resulted in a final prediction model. RESULTS AND CONCLUSIONS: During a mean of 5.9 years follow-up, 22.4% (n=52) of the patients (n=232) showed progression to late AMD. The multivariable prediction model included age, CFH variant rs1061170, pigment abnormalities, drusenoid pigment epithelial detachment (dPED), and hyperreflective foci (HRF). The model showed an area under the curve of 0.969 (95% Confidence Interval: 0.948-0.990) and adequate calibration (Hosmer-Lemeshow P= 0.797). In addition to advanced age and carrying a CFH variant, pigment abnormalities, dPED, and HRF are relevant imaging biomarkers for conversion to late AMD. In clinical routine, an intensified monitoring of patients with high risk phenotypic profile may be suitable for early detection of conversion to late AMD.