Area Under the Curve Analysis in a Real-World Cohort of Finnish Patients Treated for Neovascular Age-Related Macular Degeneration.

Abstract

Purpose: The purpose of this study was to explore the area under the curve (AUC) measures from visual acuity (VA) trajectories in describing outcomes for neovascular age-related macular degeneration (nAMD).

Methods: AUC analysis on 93 patients with nAMD was performed using VA trajectories up to 12 months for the purpose of illustration. The broken stick model was first used to interpolate VA trajectories at prespecified times from uneven timepoints over the 4 year period. The AUC measures used were: general VA (AUCG; the area above 20 Early Treatment Diabetic Retinopathy Study [ETDRS] letters), change from baseline (AUCI), and adjusted AUC (Adj AUC) to adjust the change from baseline with respect to the ceiling (85 letters) and the ground (20 letters). We studied how AUC ranking of outcomes differed from VA change from baseline and how AUC-derived parameters correlated with known prognostic factors, such as baseline VA, and optical coherence tomography findings at baseline and during treatment.

Results: Median AUCIs in ascending quartiles of baseline VA were 88, 116, 38, and 10, respectively. The corresponding Adj AUCs were 0.12, 0.28, 0.13 and 0.29 (scale -1 to +1), suggesting a compensation for the ceiling effect. Median AUCIs in patients with baseline intraretinal, intraretinal + subretinal, or subretinal fluid were 40, 50, or 59, respectively. The corresponding Adj AUCIs were 0.14, 0.19, and 0.23, both showing the expected response to baseline fluid status.

Conclusions: Using the measures described here, modifiers of VA change and different anti-vascular endothelial growth factor (VEGF) treatment protocols can be compared from only one to three of the AUC values even in materials with uneven evaluation points.

Translational relevance: AUC-based analysis provides new tools to evaluate the effectiveness of nAMD treatment.