A Risk Score for the Prediction of Advanced Age-Related Macular Degeneration

作者：Chiu Chung Jung^*; Mitchell Paul; Klein Ronald; Klein Barbara E; Chang Min Lee; Gensler Gary; Taylor Allen

来源：Ophthalmology, 2014, 121(7): 1421-1427.

DOI：10.1016/j.ophtha.2014.01.016

Purpose: To develop a clinical eye-specific prediction model for advanced age-related macular degeneration (AMD).
Design: The Age-Related Eye Disease Study (AREDS) cohort followed up for 8 years served as the training dataset, and the Blue Mountains Eye Study (BMES) cohort followed up for 10 years served as the validation dataset.
Participants: A total of 4507 AREDS participants (contributing 1185 affected vs. 6992 unaffected eyes) and 2169 BMES participants (contributing 69 affected vs. 3694 unaffected eyes).
Methods: Using Bayes' theorem in a logistic model, we used 8 baseline predictors-age, sex, education level, race, smoking status, and presence of pigment abnormality, soft drusen, and maximum drusen size-to devise and validate a macular risk scoring system (MRSS). We assessed the performance of the MRSS by calculating sensitivity, specificity, and the area under the receiver operating characteristic curve (i.e., c-index).
Main Outcome Measures: Advanced AMD.
Results: The internally validated c-index(AREDS) (0.88; 95% confidence interval, 0.87-0.89) and the externally validated c-index(BMES) (0.91; 95% confidence interval, 0.88-0.95) suggested excellent performance of the MRSS. The sensitivity and specificity at the optimal macular risk score cutoff point of 0 were 87.6% and 73.6%, respectively. An application for the iPhone and iPad also was developed as a practical tool for the MRSS.
Conclusions: The MRSS was developed and validated to provide satisfactory accuracy and generalizability. It may be used to screen patients at risk of developing advanced AMD.

• 出版日期2014-7