Dataset Information

Comparing Accuracies of Length-Type Geographic Atrophy Growth Rate Metrics Using Atrophy-Front Growth Modeling.

ABSTRACT:

Purpose

To compare the accuracies of the previously proposed square-root-transformed and perimeter-adjusted metrics for estimating length-type geographic atrophy (GA) growth rates.

Design

Cross-sectional and simulation-based study.

Participants

Thirty-eight eyes with GA from 27 patients.

Methods

We used a previously developed atrophy-front growth model to provide analytical and numerical evaluations of the square-root-transformed and perimeter-adjusted growth rate metrics on simulated and semisimulated GA growth data.

Main outcome measures

Comparison of the accuracies of the square-root-transformed and perimeter-adjusted metrics on simulated and semisimulated GA growth data.

Results

Analytical and numerical evaluations showed that the accuracy of the perimeter-adjusted metric is affected minimally by baseline lesion area, focality, and circularity over a wide range of GA growth rates. Average absolute errors of the perimeter-adjusted metric were approximately 20 times lower than those of the square-root-transformed metrics, per evaluation on a semisimulated dataset with growth rate characteristics matching clinically observed data.

Conclusions

Length-type growth rates have an intuitive, biophysical interpretation that is independent of lesion geometry, which supports their use in clinical trials of GA therapeutics. Taken in the context of prior studies, our analyses suggest that length-type GA growth rates should be measured using the perimeter-adjusted metric, rather than square-root-transformed metrics.

SUBMITTER: Moult EM

PROVIDER: S-EPMC9560575 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Comparing Accuracies of Length-Type Geographic Atrophy Growth Rate Metrics Using Atrophy-Front Growth Modeling.

Moult Eric M EM Shi Yingying Y Wang Liang L Chen Siyu S Waheed Nadia K NK Gregori Giovanni G Rosenfeld Philip J PJ Fujimoto James G JG

Ophthalmology science 20220414 3

<h4>Purpose</h4>To compare the accuracies of the previously proposed square-root-transformed and perimeter-adjusted metrics for estimating length-type geographic atrophy (GA) growth rates.<h4>Design</h4>Cross-sectional and simulation-based study.<h4>Participants</h4>Thirty-eight eyes with GA from 27 patients.<h4>Methods</h4>We used a previously developed atrophy-front growth model to provide analytical and numerical evaluations of the square-root-transformed and perimeter-adjusted growth rate me ...[more]

PMID: 36245762

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Project description:PurposeTo identify the most suitable model for assessing the rate of growth of total geographic atrophy (GA) by analysis of model structure uncertainty.MethodsModel structure uncertainty refers to unexplained variability arising from the choice of mathematical model and represents an example of epistemic uncertainty. In this study, we quantified this uncertainty to help identify a model most representative of GA progression. Fundus autofluorescence (FAF) images and GA progression data (i.e., total GA area estimation at each presentation) were acquired using Spectralis HRA+OCT instrumentation and RegionFinder software. Six regression models were evaluated. Models were compared using various statistical tests, [i.e., coefficient of determination (r2), uncertainty metric (U), and test of significance for the correlation coefficient, r], as well as adherence to expected physical and clinical assumptions of GA growth.ResultsAnalysis was carried out for 81 GA-affected eyes, 531 FAF images (range: 3-17 images per eye), over median of 57 months (IQR: 42, 74), with a mean baseline lesion size of 2.62 ± 4.49 mm2 (range: 0.11-20.69 mm2). The linear model proved to be the most representative of total GA growth, with lowest average uncertainty (original scale: U = 0.025, square root scale: U = 0.014), high average r2 (original scale: 0.92, square root scale: 0.93), and applicability of the model was supported by a high correlation coefficient, r, with statistical significance (P = 0.01).ConclusionsStatistical analysis of uncertainty suggests that the linear model provides an effective and practical representation of the rate and progression of total GA growth based on data from patient presentations in clinical settings.Translational relevanceIdentification of correct model structure to characterize rate of growth of total GA in the retina using FAF images provides an objective metric for comparing interventions and charting GA progression in clinical presentations.

Project description:PurposeTo evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy.DesignCohort within a clinical trial.ParticipantsPatients included in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).MethodsParticipants were randomly assigned to injections of ranibizumab or bevacizumab and to a 2-year dosing regimen of monthly or pro re nata (PRN) or to monthly for 1 year and PRN the following year. Digital color photographs and fluorescein angiograms at baseline and 1 and 2 years were evaluated for GA, and the total area of GA was measured by 2 graders masked to treatment; differences were adjudicated. Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic, treatment, and ocular characteristics on imaging as candidate risk factors.Main outcome measuresGeographic atrophy growth rate.ResultsAmong 1185 participants, 86 (7.3%) had GA at baseline, 120 (10.1%) developed GA during year 1, and 36 (3.0%) developed GA during year 2. Among 194 eyes evaluable for growth, the rate was 0.43 mm/yr (standard error [SE], ±0.03 mm/year). In multivariate analysis, the growth rate was 0.37 mm/year in eyes receiving bevacizumab and 0.49 mm/year in eyes receiving ranibizumab (difference, 0.11 mm/yr; 95% confidence interval [CI], 0.01-0.22; P = 0.03). Growth rate did not differ between eyes treated monthly and PRN (P = 0.85). Eyes with subfoveal choroidal neovascularization (CNV) lesions had a lower growth rate than eyes with nonsubfoveal CNV lesions (difference, 0.12; 95% CI, 0.01-0.22; P = 0.03). Eyes with GA farther from the fovea had higher growth rates by 0.14 (95% CI, 0.01-27) mm/year for every millimeter farther from the fovea. The growth rate was 0.58 mm/year for eyes with predominantly classic lesions, 0.41 mm/year for eyes with minimally classic lesions, and 0.30 mm/year for eyes with occult only lesions (P < 0.01). The growth rate in eyes having a fellow eye with GA was higher by 0.13 mm/year (95% CI, 0.01-0.24; P = 0.03) than in eyes without GA in the fellow eye. Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane (difference, 0.16; 95% CI, 0.03-0.30; P = 0.02).ConclusionsGeographic atrophy growth depends on several ocular factors. Ranibizumab may accelerate GA growth.

Dataset Information

Comparing Accuracies of Length-Type Geographic Atrophy Growth Rate Metrics Using Atrophy-Front Growth Modeling.

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Publications

Comparing Accuracies of Length-Type Geographic Atrophy Growth Rate Metrics Using Atrophy-Front Growth Modeling.

Similar Datasets

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