AMD Prognosis

Enhancing the Clinical Exam

Traditionally, eye care professionals have used the results of a clinical exam to estimate a patient's risk of progression to advanced AMD. The patient's risk was assumed to be the average progression risk for his or her disease phenotype category as determined in an AMD natural history study such as the AREDS trial. It is important to recognize that this method of risk assessment is generalized and not specific to the patient.

Illustrated below is how Macula Risk PGx enhances the clinical exam to personalize AMD risk assessment. On the left is the average 5-year progression risk for each AREDS disease category [8]. When Macula Risk PGx is added to the clinical risk assessment, a range of personalized 5-year progression risk is possible. The 5-year personalized risk ranges, displayed on the right, are specific to a high school educated 75-year-old male who is a former smoker and has a BMI of 24.

Adding Macula Risk PGx to the risk assessment reveals that there may be significant overlap between the risk assigned using the clinical eye exam with AREDS Categorization alone. For instance, some intermediate AMD (AREDS Category 3) patients may have a lower risk than some early AMD patients (AREDS Category 2). The range of risk is significant. Risk for vision loss for patients with intermediate AMD could be less than 10% or higher than 70% even though they might look the same in a clinical examination.

While intermediate AMD patients have a 5-year generalized risk of progression to advanced AMD of 18.3%, the 5-year personalized risk ranges from 7% to over 70% depending upon the patient's genetic risk. Employing Macula Risk PGx in the advanced AMD prognosis would result in patients with such a wide range of risk being managed differently, whereas in the past they may have been managed in the same manner.

The Primary Eye Care Protocol guides the doctor to adopt a personalized disease management program best suited to the patients risk for vision loss.

Macula Risk PGx provides a powerful tool for the eye care professional and retina specialist to more precisely stratify their AMD patients. This in turn informs better management practices as well as a more efficient utilization of limited resources.