Age-Related Scattered Hypofluorescent Spots as an Adverse Prognostic Factor for Polypoidal Choroidal Vasculopathy

Abstract

Purpose : Polypoidal choroidal vasculopathy (PCV) demonstrates significant prognostic variability, and the impact of age-related scattered hypofluorescent spots observed in late-phase indocyanine green angiography (ASHS-LIA) on the prognosis of PCV remains under-researched. This study aims to investigate the association between ASHS-LIA in PCV and prognosis using the AdaBoost machine learning model. Design : A cross-sectional study. Participants : The study included patients diagnosed with PCV and treated with anti-VEGF therapy at 2 medical institutions between 2012 and 2021. Methods : We conducted a retrospective analysis of the clinical characteristics, anti-VEGF treatment history, and outcomes of the participants, classifying them based on the presence or absence of ASHS-LIA. An AdaBoost meta-estimator was applied to predict prognosis, including disease stability, injection frequency, and time to first remission, utilizing features selected through principal component analysis. Main Outcome Measures : The prognostic significance of ASHS-LIA was assessed by feature importance, with the mean decrease in impurity serving as the evaluation metric. Results : Of 57 eyes with PCV, 31 exhibited ASHS-LIA and 26 did not. Compared with the non-ASHS-LIA group, the ASHS-LIA group had fewer patients who achieved a super-stable status without recurrence for >18 months postremission (P = 0.03), required a longer time to reach first remission (P = 0.04), and needed more injections (P < 0.001). AdaBoost models confirmed the importance of ASHS-LIA for predicting disease stability, injection demand, and time to first remission, ranking it as the third, seventh, and eighth top contributory factor, respectively. Conclusions : Machine learning analysis identified ASHS-LIA as a negative prognostic factor in PCV, correlating with reduced disease stability, higher recurrence rates, and increased treatment requirements. These findings suggest that ASHS-LIA could serve as a valuable marker for assessing prognosis and guiding treatment strategies in PCV management. Financial Disclosure(s) : The author(s) have no proprietary or commercial interest in any materials discussed in this article.