Photostress Recovery Time as a Potential Predictive Biomarker for Age-Related Macular Degeneration

Abstract

Purpose The purpose of this study was to assess recovery time following photostress and its association with age-related macular degeneration (AMD) cross-sectionally and longitudinally in an elderly population-based cohort. Methods We analyzed photostress recovery time (PRT) and AMD in >1800 AugUR study participants aged 70+ years. On color fundus images from baseline and 3-year follow-up, presence of AMD was graded manually (Three Continent AMD Consortium Severity Scale). Visual acuity (VA) was assessed via Early Treatment Diabetic Retinopathy Study (ETDRS) charts. After a 30-second bleaching of the macular region via direct ophthalmoscope, PRT was measured as the seconds to regain VA. Results First, we analyzed 1208 AugUR participants cross-sectionally (288 with early AMD, and 78 with late AMD). Prolonged PRT was associated with early and late AMD versus no AMD (median PRT = 119.5, 198.0 versus 80.0 seconds, respectively; logistic regression odds ratio [OR] = 1.109–1.165 per 10 seconds, P values < 0.0001). Sensitivity analyses using alternative models or restricting to participants after cataract surgery revealed similar ORs. Second, the association was confirmed in an independent cross-sectional AugUR sample ( n = 486). Third, in longitudinal analysis of 233 AugUR participants without AMD, prolonged PRT was associated with incident AMD ascertained 3 years later (follow-up time = 3.2 ± 0.2 years, OR = 1.112–1.162 per 10 seconds, P < 0.05). Overall, we demonstrate a significant association of prolonged PRT with AMD cross-sectionally and longitudinally in elderly individuals. Conclusions Prolonged PRT might capture retinal function impairment after cell damage before early AMD is visible via color fundus imaging. Translational Relevance Our results suggest PRT as quantitative predictive biomarker for incident AMD, making it potentially worthwhile also for clinical care.

Genetic Risk Score Analysis Supports a Joint View of Two Classification Systems for Age-Related Macular Degeneration

“…Study recruitment and conduct were described previously. 3 , 7 , 9 , 10 Briefly, inhabitants of the city and county of Regensburg, Germany, with ≥ 70 years of age, were identified by local registries and invited by a mailed written invitation letter to the study center at the University Hospital Regensburg. Individuals invited to AugUR1 were excluded from the invitation list for AugUR2.…”

“…Details on data collection have been described elsewhere. 3 , 7 , 9 , 10 In brief, information on lifestyle factors, metabolic parameters, and general and ocular comorbidities were gathered via a standardized face-to-face interview, medical examinations by trained medical staff, and laboratory measurements from blood or urine. 3 , 7 , 9 , 10 …”

“…Color fundus photography of the central retina and assessment of AMD features were conducted as described previously 3 , 7 , 10 ; procedures and graders were the same for both surveys, AugUR1 and AugUR2. For each eye, the presence, size (small, intermediate, and large) and area of drusen, pigment abnormalities (hyperpigmentation or depigmentation), GA, including central or paracentral location, and/or MNV were determined using gradable color fundus images.…”

The Role of Inflammation in Age-Related Macular Degeneration—Therapeutic Landscapes in Geographic Atrophy

“…Early AMD is generally asymptomatic, but individuals may be affected by delayed in dark adaptation and increased photo stress recovery times [ 6 , 7 ]. With the onset of more significant retinal degeneration, the individual may experience blurred vision, distortion of straight lines, difficulty with reading or a central scotoma.…”