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AREDS scale may predict advanced AMD progression but fall short in surrogate markers

Arch Ophthalmol. 2009;127(9):1147-1151.

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The Age-Related Eye Disease Study nine-step severity scale for grading and predicting progression of age-related macular degeneration may adequately predict progression to advanced disease but have shortcomings in surrogate markers for progression, according to a study.

Researchers used data from the Complications of Age-Related Macular Degeneration Prevention Trial (CAPT) to retrospectively review patients in the study to test the validity of the AREDS nine-step severity scale.

According to the study, the risk of developing advanced AMD was similar to that predicted by AREDS grading among patients in the CAPT. However, fluctuations in AREDS scale level over a 5-year follow-up were observed in a large subset of patients, indicating a weakness in surrogate markers of progression to advanced AMD not attributable to differences in inter-investigator grading variation.

Among CAPT patients, 33% had a two-grade or greater change in AREDS score over 5 years, but did not progress to advanced AMD, while 26% of patients with such a change exhibited progression to advanced AMD. As well, more than two-thirds of eyes in the CAPT population did not reach the most severe AREDS scale step or have a two-grade or greater change, but still progressed to advanced AMD.

"Thus, using change in the AREDS scale step as a surrogate outcome would not decrease the time to observing an outcome relative to development of advanced AMD in the majority of eyes," the study authors said.