High risk does not guarantee high accuracy-Evaluating the prognostic accuracy of OCT biomarkers for predicting late AMD.

Matt Trinh, Rene Cheung, Judy Nam, David Ng, Lisa Nivison-Smith, Angelica Ly
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Abstract

Purpose: The translation of high-risk biomarkers into accurate predictions of late age-related macular degeneration (AMD) may be limited by biomarker prevalence, subjective identification and competing risks from concurrent biomarkers. This study evaluates the prognostic performance of key optical coherence tomography (OCT) biomarkers for progression to late AMD, with colour fundus photography (CFP) as the reference standard.

Methods: This retrospective study included 78 single eyes with intermediate AMD, propensity-score matched by age and sex between converters and non-converters to late AMD. Ten OCT biomarkers empirically derived from recent meta-analysis, alongside CFP biomarkers of large drusen and pigmentary abnormality, were independently graded by three clinician-researchers. Biomarkers' associated risk (odds ratios) and prognostic performance (area under the receiver operating characteristic curve (AUC), sensitivity, specificity) were evaluated for predicting late AMD.

Results: The adjusted risk was highest for OCT-detected nascent geographic atrophy, shallow irregular retinal pigment epithelium (RPE) elevations, drusenoid pigment epithelium detachment and RPE reflective abnormality (odds ratios, 6.66 [1.32, 42.71] to 28.27 [2.44, 545.3], p < 0.05). However, CFP-detected pigmentary abnormalities demonstrated the highest individual prognostic accuracy (77.69 [68.11, 87.27]% AUC, p < 0.0001), with excellent sensitivity (92.31%) but moderate specificity (63.08%). Adding at least three OCT biomarkers was required to improve prognostic performance significantly (91.01 [84.66, 97.36]%, p < 0.0001), and at least eight additional biomarkers to yield both excellent sensitivity (94.62%) and specificity (90.77%).

Conclusions: CFP-detected pigmentary abnormality remains a mainstay of clinical AMD prognostication, likely due to its higher prevalence and interpretability than high-risk OCT biomarkers. Integrating OCT biomarkers into clinical prognostic models is promising but complex and may require automated identification to aid efficiency.

高风险不保证高准确性-评估OCT生物标志物预测晚期AMD的预后准确性。
目的:将高风险生物标志物转化为准确预测晚期年龄相关性黄斑变性(AMD)可能受到生物标志物流行程度、主观识别和同时存在的生物标志物的竞争风险的限制。本研究以彩色眼底摄影(CFP)作为参考标准,评估了关键光学相干断层扫描(OCT)生物标志物对晚期AMD进展的预后性能。方法:本回顾性研究纳入78只患有中度黄斑变性的单眼,晚期黄斑变性者和非黄斑变性者的倾向评分按年龄和性别匹配。从最近的荟萃分析中得出的10个OCT生物标志物,以及大结节和色素异常的CFP生物标志物,由三位临床研究人员独立分级。评估生物标志物的相关风险(优势比)和预后表现(受试者工作特征曲线下面积(AUC)、敏感性和特异性)以预测晚期AMD。结果:OCT检测到的新生地理萎缩、浅不规则视网膜色素上皮(RPE)升高、类荚膜色素上皮脱离和RPE反射异常的校正风险最高(优势比为6.66[1.32,42.71]至28.27 [2.44,545.3],p)。结论:cfp检测到的色素异常仍然是临床AMD预后的主要指标,可能是由于其比高危OCT生物标志物具有更高的患病率和可解释性。将OCT生物标志物整合到临床预后模型中是有希望的,但很复杂,可能需要自动识别以提高效率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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