Quantifying the extent of hyperpigmentary abnormalities (HPAs) may not improve the ability to predict progression to late or atrophic age-related macular degeneration (AMD) compared with monitoring HPA presence alone, according to research published in the British Journal of Ophthalmology. However, HPA extent may be associated with local visual sensitivity reductions and may serve as an imaging biomarker of visual dysfunction, according to the report.
Researchers included 140 participants (mean age, 70 years; 77% women) from the sham treatment arm of the Laser Intervention in the Early Stages of AMD (LEAD; Clinical Trials.gov Identifier: NCT04776031) in the study. All participants had large bilateral drusen (>125 μm within 1500 μm of the fovea) and underwent multimodal imaging, optical coherence tomography (OCT), and fundus autofluorescence at baseline and every 6 months during the 3-year study duration. Two graders monitored the data for progression to late AMD, defined by neovascularization, geographic atrophy, or nascent geographic atrophy.
A total of 48 eyes (17%) progressed to late AMD — 40 developed atrophic AMD and 8 developed neovascular AMD. Among the subset of eyes that developed late AMD, 71% had HPAs at baseline.
Using the presence of HPAs demonstrated a similar ability to using the extent of HPAs for predicting late AMD (area under the curve [AUC], 0.85 for both; P =.92). Similarly, using the presence and extent of HPAs performed similarly for predicting atrophic AMD (AUC, 0.88 vs 0.88; P =.98), respectively.
Using the presence or extent of HPAs did not result in different sensitivities for predicting late AMD (42% vs 50%; P =.21) or atrophic AMD (47% vs 55%; P =.32), according to the report.
The total extent of HPAs in the central 20×20° foveal region at baseline did not affect the overall mean visual sensitivity (P =.431), the report shows, but the extent in each sector did affect visual sensitivity at the corresponding sector ( P <.001).
“This study showed that quantifying HPA extent did not significantly improve the prediction of progression to late AMD, as compared with evaluating their mere presence alone,” according to the study authors. “However, an increasing extent of HPAs was significantly associated with localized decreases in visual sensitivity on microperimetry and as such may serve as a useful imaging-based biomarker of visual sensitivity loss in the early stages of AMD.”
Study limitations included the limited number of neovascular AMD endpoints reached and the strict inclusion of individuals with bilateral large drusen.
Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures.
Goh KL, Kumar H, Hadoux X, et al. Hyperpigmentary abnormalities in age-related macular degeneration: association with progression and impact on visual sensitivity. Br J Ophthalmol. Published online December 23, 2022. doi:10.1136/bjo-2022-322676