Suitability of Machine Learning for Atrophy and Fibrosis Development in Neovascular Age-Related Macular Degeneration

Abstract

Anti-VEGF therapy has reduced the risk of legal blindness on neovascular age-related macular degeneration (nAMD), but still several patients develop fibrosis or atrophy in the long-term. Although recent statistical analyses have associated genetic, clinical and imaging biomarkers with the prognosis of patients with nAMD, no studies on the suitability of machine learning (ML) techniques have been conducted. We perform an extensive analysis on the use of ML to predict fibrosis and atrophy development on nAMD patients at 36 months from start of anti-VEGF treatment, using only data from the first 12 months. We use data collected according to real-world practice, which includes clinical and genetic factors. The ML analysis consistently found ETDRS to be relevant for the prediction of atrophy and fibrosis, confirming previous statistical analyses, while genetic variables did not show statistical relevance. The analysis also reveals that predicting one macular degeneration is a complex task given the available data, obtaining in the best case a balance accuracy of 63% and an AUC of 0.72. The lessons learnt during the development of this work can guide future ML-based prediction tasks within the ophthalmology field and help design the data collection process.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work has been developed by members of the Spanish Vitreoretinal society (SERV) and Inflammatory Disease Network (RICORS REI). It has been supported in part by a grant of Thematic Network of Cooperative Health Research in Eye Diseases (Oftared) (RD16/0008/0021) and Gangoiti Foundation. Furthermore, this work has been funded by the FIS project PI15/01374, integrated in the National Plan of I+D+I 2013-2016, the ISCIII Thematic Network of Cooperative Health Research General Subdirection, the European Program FEDER and, partially, by a grant from the Multiopticas Foundation. I.O. was supported by a Gipuzkoa Fellows grant from the Basque Government, a Ramon y Cajal Grant from Spain, and a grant from the Spanish Ministry of Science and Innovation (PID2021-126718OA-I00). J.F.C. was supported by a Fulbright fellowship.

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All procedures carried out in this study were in accordance with the guidelines of the Declaration of Helsinki. The Institutional Review Board and the Ethics Committee of Clinica Universidad de Navarra (CUN-RAN-2016-01) and Government of Navarra, Spain (EO16/19), approved the protocols used in this study. All patients were fully informed of the purpose and procedures, and written consent was obtained from each patient.

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