Risk factors for the progression of age-related macular degeneration in patients of the Ukrainian population

Authors

  • Sergiy Mogilevskyy Shupyk National Healthcare University of Ukraine
  • Tetiana Zavgorodnia Shupyk National Healthcare University of Ukraine

DOI:

https://doi.org/10.31288/oftalmolzh202413743

Keywords:

AREDS, visual acuity, drusen, RPE changes, subretinam neovascular membrane, geographic atrophy, model of disease progression

Abstract

Background: Researchers need to find informative age-related macular degeneration (AMD) criteria which could be used for developing expert systems for the prediction of the course of the disease.
Purpose: To evaluate risk factors of AMD progression on the basis of clinical and ophthalmological characteristics in patients of the Ukrainian population.
Material and Methods: Totally, 302 eyes (152 patients) with AMD were included in the study. The stage of AMD was determined based on the Age-related Eye Disease Study (AREDS) guidelines. Median patient age (95% confidence interval (CI)) was 71.18 (69.47 – 72.89) years, most (82.9%) patients were of 60 – 85 years, and the percentage of women was 59.9%. Visual acuity, best-corrected visual acuity (BCVA), numbers of small, intermediate and large drusen, presence of retinal pigment epithelium (RPE) changes, subretinal neovascular membranes (SNM), and geographic RPE atrophy were assessed at baseline and at 1 year and 2 years. Statistical analyses were conducted using MedStat and MedCalc v.15.1 (MedCalc Software bvba, Ostende, Belgium) and EZR v.1.64 software (R Foundation for Statistical Computing, Austria).
Results: There was a slow but statistically significant reduction in median BCVA (interquartile range (IQR)) from 0.4 (0.1–0.85) at baseline to 0.325 (0.1 – 0.8) (p < 0.001) at 2 years. Over the first year and over the second year, the frequency of RPE changes increased by 6.3% and 10.9%, respectively (p < 0.001), the frequency of SNM detection increased by 13.3% and 21.2%, respectively (p < 0.001), and the frequency of geographic atrophy detection, by 5.7% and 8.0%, respectively (p < 0.001). A multivariate logistic regression model was developed to select four covariates for the risk of AMD progression (the male gender, BCVA, number of small drusen and AREDS category at baseline). The BCVA was negatively associated (р = 0.026; OR = 0.12; 95% CI, 0.03 – 0.60), whereas the number of small drusen was positively associated with the risk of AMD progression (р = 0.009; OR = 1.02; 95% CI, 1.00–1.04). The risk of AMD progression was the highest for eyes with the AREDS category 2 (63.0%, 95% CI, 48.7% – 75.7 %), and the lowest for eyes with the AREDS category 3 (41.2 %, 95% CI, 29.4% – 53.8%, р = 0.049).
Conclusion: First, over 24 months, we observed a slow but statistically significant reduction in visual acuity, with an increase in the frequency of RPE changes and detection of SNM and geographic atrophy. Second, a multivariate logistic regression model was developed to select four covariates for the risk of AMD progression (the male gender, BCVA, number of small drusen and AREDS category at baseline). The BCVA was negatively associated, whereas the number of small drusen was positively associated with the risk of AMD progression. Finally, the risk of AMD progression was the highest for eyes with the AREDS category 2, and the lowest for eyes with the AREDS category 3.

References

Wong WL, SuX, LiX, Cheung CM, Klein R, Cheng CY, Wong TY. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014 Feb;2(2):e106-16. https://doi.org/10.1016/S2214-109X(13)70145-1

Jin G, Zou M, Chen A, Zhang Y, Young CA, Wang SB, Zheng D. Prevalence of age-related macular degeneration in Chinese populations worldwide: A systematic review and meta-analysis. Clin Exp Ophthalmol. 2019 Nov;47(8):1019-1027. https://doi.org/10.1111/ceo.13580

Forshaw TRJ, Kjaer TW, Andréasson S, Sørensen TL. Full-field electroretinography in age-related macular degeneration: an overall retinal response. Acta Ophthalmol. 2021 Mar;99(2):e253-e259. Epub 2020 Aug 24. PMID: 32833310. https://doi.org/10.1111/aos.14571

Dimopoulos IS, Tennant M, Johnson A, Fisher S, Freund PR, Sauvé Y. Subjects with unilateral neovascular AMD have bilateral delays in rod-mediated photo transduction activation kinetic sand in dark adaptation recovery. Invest Ophthalmol Vis Sci. 2013 Aug 5;54(8):5186-95. https://doi.org/10.1167/iovs.13-12194

Novytskyy IY, Tomkiv UM. [Age-related macular degeneration: current aspects of the pathogenesis, diagnosis and treatment]. Zdorov'ia Ukrainy 21 storichchia. 2021;6(499). Ukrainian Available at: https://health-ua.com/article/64703-vkova-makulyarna-degeneratcya-suchasn-aspekti-patogenezu-dagnostikitalkuvan

Rizaiev ZhA, Iangiieva NR, Lokes KP. [Developing the method for the prediction of the risk for the onset and early identification of age-related macular degeneration]. Visnyk problem biologii i medytsyny. 2020; 1(155):260-264. Ukrainian.

Lutsenko NS, Rudycheva OA, Isakova OA, Kyrylova TS. Assessing OCTA changes in morphology and condition of retinal microvascular bed in patients with exudative AMD. J of Ophthalmology (Ukraine). 2019;2:7-13. Ukrainian. https://doi.org/10.31288/oftalmolzh20192713

Lambert NG, El Shelmani H, Singh MK, Mansergh FC, Wride MA, Padilla M, et al. Risk factors and biomarkers of age-related macular degeneration. Prog Retin Eye Res. 2016 Sep;54:64-102. https://doi.org/10.1016/j.preteyeres.2016.04.003

Sleiman K, Veerappan M, Winter KP, McCall MN, Yiu G, Farsiu S, et al. Age-Related Eye Disease Study 2 Ancillary Spectral Domain Optical Coherence Tomography Study Group. Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration. Ophthalmology. 2017 Dec;124(12):1764-1777. https://doi.org/10.1016/j.ophtha.2017.06.032

Qidwai U, Qidwai U, Raja M, Burton B. Smart AMD prognosis through cellphone: an innovative localized AI-based prediction system for anti-VEGF treatment prognosis in nonagenarians and centenarians. Int Ophthalmol. 2022 Jun;42(6):1749-1762. Epub 2022 Jan 30. PMID: 35094227. https://doi.org/10.1007/s10792-021-02171-8

Age-Related Eye Disease Study Research Group. The Age-Related Eye Disease Study (AREDS): design implications. AREDS report no. 1. Control Clin Trials. 1999 Dec;20(6):573-600. https://doi.org/10.1016/S0197-2456(99)00031-8

Gur'ianov VG, Liakh II, Parii VD, Korotkyi OV, Chalyi OV, Tsekhmister IV. [Analysis of the results of medical studies using EZR (R-statistics) software: Biostatistics training manual]. Kyiv: Vistka; 2018. Ukrainian.

Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013 Mar;48(3):452-8. https://doi.org/10.1038/bmt.2012.244

Lin X, Lou L, Miao Q, Wang Y, Jin K, Shan P, Xu Y. The pattern and gender disparity in global burden of age-related macular degeneration. Eur J Ophthalmol. 2021 May;31(3):1161-1170. https://doi.org/10.1177/1120672120927256

Zou M, Zhang Y, Chen A, Young CA, Li Y, Zheng D, Jin G. Variations and trends in global disease burden of age-related macular degeneration: 1990-2017. ActaOphthalmol. 2021 May;99(3):e330-e335. https://doi.org/10.1111/aos.14589

Bezkorovaina IM. [Risk factors for the development of age-related macular degeneration]. Tavricheskii medico-biologicheskii vestnik. 2013;16,3,2(63):29-31. Russian.

Schultz NM, Bhardwaj S, Barclay C, Gaspar L, Schwartz J. Global Burden of Dry Age-Related Macular Degeneration: A Targeted Literature Review. ClinTherа. 2021 Oct;43(10):1792-1818. https://doi.org/10.1016/j.clinthera.2021.08.011

Al-Zamil WM, Yassin SA. Recent developments in age-related macular degeneration: a review. Clin Interv Aging. 2017 Aug 22;12:1313-1330. https://doi.org/10.2147/CIA.S143508

Flores R, Carneiro Â, Vieira M, Tenreiro S, Seabra MC. Age-Related Macular Degeneration: Pathophysiology, Management, and Future Perspectives. Ophthalmologica. 2021;244(6):495-511. https://doi.org/10.1159/000517520

Bhutto I, Lutty G. Understanding age-related macular degeneration (AMD): relationships between the photoreceptor/retinal pigment epithelium/Bruch's membrane/choriocapillaris complex. Mol Aspects Med. 2012 Aug;33(4):295-317. https://doi.org/10.1016/j.mam.2012.04.005

Lim LS, Mitchell P, Seddon JM, Holz FG, Wong TY. Age-related macular degeneration. Lancet. 2012 May 5;379(9827):1728-38. https://doi.org/10.1016/S0140-6736(12)60282-7

Thomas CJ, Mirza RG, Gill MK. Age-Related Macular Degeneration. Med Clin North Am. 2021 May;105(3):473-491. https://doi.org/10.1016/j.mcna.2021.01.003

Lad EM, Finger RP, Guymer R. Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration. Ophthalmol Ther. 2023 Dec;12(6):2917-2941. https://doi.org/10.1007/s40123-023-00807-9

Shin KU, Song SJ, Bae JH, Lee MY. Risk Prediction Model for Progression of Age-Related Macular Degeneration. Ophthalmic Res. 2017;57(1):32-36. https://doi.org/10.1159/000449168

Published

2024-02-29

How to Cite

1.
Mogilevskyy S, Zavgorodnia T. Risk factors for the progression of age-related macular degeneration in patients of the Ukrainian population. J.ophthalmol. (Ukraine) [Internet]. 2024 Feb. 29 [cited 2024 Oct. 11];(1):37-43. Available from: https://ua.ozhurnal.com/index.php/files/article/view/125

Issue

Section

Clinical Ophthalmology