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.