Hyperpigmentary abnormalities in age-related macular degeneration: association with progression and impact on visual sensitivity

Background/aimsTo investigate the additional prognostic value of quantifying the extent of colour fundus photography (CFP)-defined hyperpigmentary abnormalities (HPAs) compared with their presence alone for predicting progression to late-stage age-related macular degeneration (AMD) and to understand their association with visual sensitivity in individuals with intermediate AMD. Methods140 participants with bilateral large drusen underwent multimodal imaging and microperimetry at baseline and then every 6 months for up to 3 years. Baseline CFPs were graded for the presence of HPAs and their extent was quantified. Optical coherence tomography (OCT) scans were used to quantify drusen volume. Predictive models for progression to late AMD (including OCT signs of atrophy) were developed using either HPA presence or extent. The association between HPA extent with mean visual sensitivity (both overall and sector based) was also evaluated. All models were adjusted for the confounders of baseline age and drusen volume. ResultsThe predictive performance for late AMD development was not significantly different for HPA presence or extent (p=0.92). Increasing HPA extent in each sector, but not its overall extent in an eye, was associated with reduced sector-based visual sensitivity (p<0.001 and p=0.671, respectively). ConclusionIn a cohort with bilateral large drusen, quantifying HPA extent did not improve the prediction of late AMD development compared with presence alone. HPA extent was associated with more local, rather than generalised, reductions in visual sensitivity. These findings suggest that quantification of HPA extent adds little to the prediction of AMD progression, but that it provides an imaging biomarker of visual dysfunction.

Automated summary

This study aimed to investigate the additional prognostic value of quantifying the extent of hyperpigmentary abnormalities (HPAs) defined by color fundus photography (CFP) and their association with visual sensitivity in individuals with intermediate age-related macular degeneration (AMD). The results showed that quantifying the extent of HPAs did not improve the prediction of late AMD development compared to the presence alone, and the extent of HPAs was associated with localized reductions in visual sensitivity. Overall, these findings suggest that quantifying the extent of HPAs provides little additional information for predicting AMD progression but serves as an imaging biomarker for visual dysfunction.