Association between Patient-Reported Outcomes and Time to Late Age-Related Macular Degeneration in the Laser Intervention in Early Stages of Age-Related Macular Degeneration Study
Association between Patient-Reported Outcomes and Time to Late Age-Related Macular Degeneration in the Laser Intervention in Early Stages of Age-Related Macular Degeneration Study
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DOI：
10.1016/j.oret.2020.03.015
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发表时间：
2020-09-01
影响因子：
4.5
通讯作者：
Guymer, Robyn H.
中科院分区：
文献类型：
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作者：
McGuinness, Myra B.;Finger, Robert P.;Guymer, Robyn H.
目的：调查双侧大玻璃膜疣个体中患者报告的结果 (PRO) 问卷反应与晚期年龄相关性黄斑变性（AMD；新生血管性 AMD [nAMD] 或多模态成像 [MMI] 定义的萎缩）的时间之间的关系，以及 36 个月 AMD 状态的基线 PRO 的预后价值。 设计：来自 AMD 干预的多中心随机对照试验的探索性分析（澳大利亚新西兰临床试验注册标识符， ACTRN12612000704897)。参与者：年龄相关性黄斑变性 (LEAD) 早期激光干预研究的假治疗组（n = 141；年龄，50-88 岁；77% 女性）。方法：28 项视力障碍影响 (IVI-28) 和 10 项夜视问卷 (NVQ-10)在基线访视时进行。 PRO 分数是使用评级量表模型得出的。 Multivariate Cox regression adjusting for demographics and clinical measures of vision (low-luminance visual acuity, low-luminance deficit, and microperimetric sensitivity) from the poorer-performing eye was used to investigate the association between PRO scores and time to late AMD in either eye.使用多变量竞争风险回归来估计任意一只眼睛的 nAMD 和萎缩的特定原因子危险比。使用交叉验证的逻辑套索模型来估计 36 个月时发生 AMD 的预测概率。评估受试者工作特征曲线下的面积，以比较具有和不具有 PRO 的模型之间的预后准确性。主要结果测量：任一只眼睛发生 nAMD 或萎缩的时间。结果：PRO 分数偏向于更高的功能性视力。 IVI-28 评分较高与进展为 MMI 定义的萎缩的风险较低相关（20 个事件：调整后的风险比，0.65/logit 增加；P = 0.002），但与 nAMD 无关（10 个事件；P = 0.562）。没有足够的证据表明 NVQ-10 评分与晚期 AMD 进展率之间存在关联 (P >= 0.149)。研究发现，基线 IVI-28 评分有助于 36 个月就诊时的萎缩预后（P = 0.010）。结论：平均而言，PRO 与从中度 AMD 进展为 MMI 定义的萎缩的风险增加相关。持续开发记录 AMD 早期阶段 PRO 的仪器有可能产生廉价且高效的工具，以协助评估疾病严重程度和 AMD 进展风险。 (C) 2020 by the American Academy of Ophthalmology
Purpose: To investigate the relationship between patient-reported outcome (PRO) questionnaire responses and time to late age-related macular degeneration (AMD; neovascular AMD [nAMD] or multimodal imaging [MMI]-defined atrophy) among individuals with bilateral large drusen, and the prognostic value of baseline PROs for 36-month AMD status.Design: Exploratory analyses from a multicenter randomized controlled trial of an AMD intervention (Australian New Zealand Clinical Trials Registry identifier, ACTRN12612000704897).Participants: Sham treatment group of the Laser Intervention in Early Stages of Age-Related Macular Degeneration (LEAD) Study (n = 141; age, 50-88 years; 77% female).Methods: The 28-item Impact of Vision Impairment (IVI-28) and 10-item Night Vision Questionnaire (NVQ-10) were administered at the baseline visit. The PRO scores were derived using rating scale models. Multivariate Cox regression adjusting for demographics and clinical measures of vision (low-luminance visual acuity, low-luminance deficit, and microperimetric sensitivity) from the poorer-performing eye was used to investigate the association between PRO scores and time to late AMD in either eye. Multivariate competing-risk regression was used to estimate cause-specific subhazard ratios for nAMD and atrophy in either eye. Cross-validated logistic lasso models were used to estimate the predicted probability of AMD at 36 months. The area under the receiver operating characteristic curve was assessed to compare prognostic accuracy between models with and without PROs.Main Outcome Measure: Time until nAMD or atrophy in either eye.Results: The PRO scores were skewed toward higher functional vision. Higher IVI-28 scores were associated with a lower risk of progression to MMI-defined atrophy (20 events: adjusted hazard ratio, 0.65/logit increase; P = 0.002) but not nAMD (10 events; P = 0.562). Insufficient evidence was found of an association between NVQ-10 score and rate of progression to late AMD (P >= 0.149). Baseline IVI-28 scores were found to contribute to the prognosis of atrophy at the 36-month visit (P = 0.010).Conclusions: On average, PROs were associated with an increased risk of progression from intermediate AMD to MMI-defined atrophy. Continuing development of instruments to record PROs in the early stages of AMD have the potential to produce inexpensive and efficient tools to assist in the assessment of disease severity and risk of AMD progression. (C) 2020 by the American Academy of Ophthalmology