Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration
Abstract Age-related macular degeneration (AMD) is a leading cause of severe vision loss worldwide, with a global prevalence that is predicted to substantially increase. Identifying early biomarkers indicative of progression risk will improve our ability to assess which patients are at greatest risk...
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2023-09-01
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| Series: | Ophthalmology and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40123-023-00807-9 |
| _version_ | 1797630411768070144 |
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| author | Eleonora M. Lad Robert P. Finger Robyn Guymer |
| author_facet | Eleonora M. Lad Robert P. Finger Robyn Guymer |
| author_sort | Eleonora M. Lad |
| collection | DOAJ |
| description | Abstract Age-related macular degeneration (AMD) is a leading cause of severe vision loss worldwide, with a global prevalence that is predicted to substantially increase. Identifying early biomarkers indicative of progression risk will improve our ability to assess which patients are at greatest risk of progressing from intermediate AMD (iAMD) to vision-threatening late-stage AMD. This is key to ensuring individualized management and timely intervention before substantial structural damage. Some structural biomarkers suggestive of AMD progression risk are well established, such as changes seen on color fundus photography and more recently optical coherence tomography (drusen volume, pigmentary abnormalities). Emerging biomarkers identified through multimodal imaging, including reticular pseudodrusen, hyperreflective foci, and drusen sub-phenotypes, are being intensively explored as risk factors for progression towards late-stage disease. Other structural biomarkers merit further research, such as ellipsoid zone reflectivity and choriocapillaris flow features. The measures of visual function that best detect change in iAMD and correlate with risk of progression remain under intense investigation, with tests such as dark adaptometry and cone-specific contrast tests being explored. Evidence on blood and plasma markers is preliminary, but there are indications that changes in levels of C-reactive protein and high-density lipoprotein cholesterol may be used to stratify patients and predict risk. With further research, some of these biomarkers may be used to monitor progression. Emerging artificial intelligence methods may help evaluate and validate these biomarkers; however, until we have large and well-curated longitudinal data sets, using artificial intelligence effectively to inform clinical trial design and detect outcomes will remain challenging. This is an exciting area of intense research, and further work is needed to establish the most promising biomarkers for disease progression and their use in clinical care and future trials. Ultimately, a multimodal approach may yield the most accurate means of monitoring and predicting future progression towards vision-threatening, late-stage AMD. |
| first_indexed | 2024-03-11T11:07:54Z |
| format | Article |
| id | doaj.art-df08827347544b51a8d2a3e9dabc2e6f |
| institution | Directory Open Access Journal |
| issn | 2193-8245 2193-6528 |
| language | English |
| last_indexed | 2024-03-11T11:07:54Z |
| publishDate | 2023-09-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Ophthalmology and Therapy |
| spelling | doaj.art-df08827347544b51a8d2a3e9dabc2e6f2023-11-12T12:08:49ZengAdis, Springer HealthcareOphthalmology and Therapy2193-82452193-65282023-09-011262917294110.1007/s40123-023-00807-9Biomarkers for the Progression of Intermediate Age-Related Macular DegenerationEleonora M. Lad0Robert P. Finger1Robyn Guymer2Department of Ophthalmology, Duke University Medical CenterDepartment of Ophthalmology, Medical Faculty Mannheim, Heidelberg UniversityCentre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of MelbourneAbstract Age-related macular degeneration (AMD) is a leading cause of severe vision loss worldwide, with a global prevalence that is predicted to substantially increase. Identifying early biomarkers indicative of progression risk will improve our ability to assess which patients are at greatest risk of progressing from intermediate AMD (iAMD) to vision-threatening late-stage AMD. This is key to ensuring individualized management and timely intervention before substantial structural damage. Some structural biomarkers suggestive of AMD progression risk are well established, such as changes seen on color fundus photography and more recently optical coherence tomography (drusen volume, pigmentary abnormalities). Emerging biomarkers identified through multimodal imaging, including reticular pseudodrusen, hyperreflective foci, and drusen sub-phenotypes, are being intensively explored as risk factors for progression towards late-stage disease. Other structural biomarkers merit further research, such as ellipsoid zone reflectivity and choriocapillaris flow features. The measures of visual function that best detect change in iAMD and correlate with risk of progression remain under intense investigation, with tests such as dark adaptometry and cone-specific contrast tests being explored. Evidence on blood and plasma markers is preliminary, but there are indications that changes in levels of C-reactive protein and high-density lipoprotein cholesterol may be used to stratify patients and predict risk. With further research, some of these biomarkers may be used to monitor progression. Emerging artificial intelligence methods may help evaluate and validate these biomarkers; however, until we have large and well-curated longitudinal data sets, using artificial intelligence effectively to inform clinical trial design and detect outcomes will remain challenging. This is an exciting area of intense research, and further work is needed to establish the most promising biomarkers for disease progression and their use in clinical care and future trials. Ultimately, a multimodal approach may yield the most accurate means of monitoring and predicting future progression towards vision-threatening, late-stage AMD.https://doi.org/10.1007/s40123-023-00807-9Age-related macular degenerationBiomarkersiAMDGeographic atrophyNeovascular AMD |
| spellingShingle | Eleonora M. Lad Robert P. Finger Robyn Guymer Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration Ophthalmology and Therapy Age-related macular degeneration Biomarkers iAMD Geographic atrophy Neovascular AMD |
| title | Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration |
| title_full | Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration |
| title_fullStr | Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration |
| title_full_unstemmed | Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration |
| title_short | Biomarkers for the Progression of Intermediate Age-Related Macular Degeneration |
| title_sort | biomarkers for the progression of intermediate age related macular degeneration |
| topic | Age-related macular degeneration Biomarkers iAMD Geographic atrophy Neovascular AMD |
| url | https://doi.org/10.1007/s40123-023-00807-9 |
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