Tomographic phenotypes and conditional time to atrophic conversion in dry age-related macular degeneration among progressors: an interval-censored study.

PURPOSE: Identifying progression trajectories of intermediate age-related macular degeneration (iAMD) is crucial to determine candidates for future therapies. This study assessed whether the OCT phenotype could predict the progression to complete retinal pigment epithelium and outer retinal atrophy (cRORA).

METHODS

This retrospective study included eyes with dry AMD progressing to cRORA. Baseline OCT phenotypes were assigned with a stepwise clinical rationale: incomplete RORA (iRORA) > acquired vitelliform lesions (AVL) > drusenoid pigment epithelial detachment (dPED) > subretinal drusenoid deposits (SDD) > soft drusen, with soft drusen as the reference group. Time to cRORA was estimated with accelerated failure time models.

RESULTS

Among the 129 eyes of 89 patients progressing to cRORA, the median time to cRORA for the overall cohort was 4.83 years. Eyes with iRORA showed the shortest median time to cRORA (0.75 years), followed by dPED (2.53 years) and AVL (4.07 years). SDD and soft drusen demonstrated the slowest progression (6.76 and 6.48 years, respectively). In adjusted AFT models baseline hyperreflective foci (HRF), iRORA (TR, 0.21; 95% CI, 0.13-0.33; p < 0.001) and dPED (TR, 0.59; 95% CI, 0.40-0.86; p = 0.007) independently predicted shorter time to cRORA. Presence of HRF was independently associated with faster progression (TR, 0.57; 95% CI, 0.44-0.74; p < 0.001).

CONCLUSION

In eyes with dry AMD progressing to cRORA, baseline OCT phenotypes were associated with different temporal trajectories to cRORA. These findings will help prognostic stratification and the selection of candidates for emerging therapeutic interventions.