Personalised Monitoring of Early and Intermediate Age-related Macular Degeneration With Artificial Intelligence and Identification of Disease Progression (SUDETES)

Personalised Monitoring of Early and Intermediate Age-related Macular Degeneration With Artificial Intelligence and Identification of Disease Progression in a Prospective, Multinational, Multicentre Observational Study

The goal of this prospective, multinational, multicenter observational study is to to predict conversion of early and intermediate AMD with functional vision to advanced AMD with irreversible loss of vision on an individual-based level over 2 years. The main objectives of this study are:

• Identify and quantify focal and global alterations in the retina in regard to disease progression.
• Assess the individual risk of disease progression in intermediate AMD patients converting to advanced AMD based on imaging.
• Specify the course of disease in regard to the sequence of events that lead to the conversion to advanced AMD
• Enhance the ability to classify AMD using artificial intelligence in addition to traditional models.

All patients will be followed for 24 months with 6 month intervals to assess clinical changes. Monitoring of disease progression will be performed using the following routine in-vivo imaging procedures:

• Scanning Laser Fundus Photography
• Color Fundus Photography (CFP)
• Optical Coherence Tomography (OCT)
• Optical Coherence Tomography Angiography (OCTA) Patients will be asked for their medical history. Standard ophthalmic examination, as well as a questionnaire on visual function will be carried out.

No intervention will be performed during the study since no treatment is yet available within Europe. As soon as treatment is approved in the EU, patients in this cohort might receive treatment according to availability in their respective country and standard of care. If treatment will be performed, it will be as standard of care outside the study according to each country's standard of care and by EMA label.

Study Overview

• Status: Recruiting
• Conditions: Age-Related Macular Degeneration

• Study Type: Observational
• Enrollment (Estimated): 500

Contacts and Locations

• Study Contact: Name: Gregor Reiter, Priv.-Doz. Ing. DDr., BA MSc; Phone Number: +43 1 40400-73419; Email: gregor.reiter@meduniwien.ac.at

Study Locations

• Austria
  • Vienna, Austria, 1090
    • Not yet recruiting
    • Medical University of Vienna
    • Contact: Gregor S Reiter, MD, PhD; Phone Number: +4314040073419; Email: gregor.reiter@meduniwien.ac.at
• France
  • Dijon, France
    • Recruiting
    • CHU Dijon
    • Contact: Catherine Creuzot-Garcher, MD; Phone Number: +33380293756; Email: catherine.creuzot-garcher@chu-dijon.fr
• Slovenia
  • Ljubljana, Slovenia
    • Recruiting
    • University Medical Center Ljubljana
    • Contact: Polona Jaki-Mekjavic, MD; Phone Number: +38615221900; Email: polona.jakimekjavic@kclj.si
• Spain
  • Barcelona, Spain
    • Recruiting
    • Fundacio de Recerca Clinic Barcelona-Institut D Investigacions Biomed
    • Contact: Javier Zarranz-Ventura, MD; Phone Number: +34 617 92 62 50; Email: zarranz@clinic.cat
• Switzerland
  • Binningen, Switzerland
    • Recruiting
    • Vista Klinik Binningen
    • Contact: Katja Hatz, MD; Phone Number: +41 61 426 60 79; Email: Katja.Hatz@vista.ch
  • Zürich, Switzerland
    • Recruiting
    • University of Zurich
    • Contact: Daniel Barthelmes, MD; Phone Number: +41 43 253 05 98; Email: Daniel.Barthelmes@usz.ch
• United Kingdom
  • Belfast, United Kingdom
    • Recruiting
    • Queen's Unviversity Belfast
    • Contact: Ruth Hogg, MD; Phone Number: +44(0)7734671087; Email: r.e.hogg@qub.ac.uk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients will be recruited from each center's respective outpatient clinic and/or by referral from primary eye care (e.g. optometrist).

Description

Inclusion Criteria:

• Age: 55-99 years old
• Early or intermediate AMD in at least one eye (drusen > 63 µm and/or any definite hyper- or hypopigmentary abnormalities with or without reticular pseudodrusen)
• If both eyes are eligible, both eyes will be included in the cohort study.
• Clear optical media and adequate pupillary dilation for imaging and functional testing.

Exclusion Criteria:

• Any surgical treatment of the eye within 3 months prior to baseline in the study eye
• History of anti-VEGF treatment in the study eye before baseline
• History of pseudophakic cystoid macular edema (Irvine Gass Syndrome) in the study eye
• History of uncontrolled glaucoma in the study eye (defined as intraocular pressure (IOP) ≥ 25 mmHg despite treatment with IOP lowering medication), or C/D Ratio > 0.9
• Any concurrent intraocular condition in the study eye (e.g. advanced cataract or moderate/severe diabetic retinopathy) that, in the opinion of the investigator, will most likely require medical or surgical intervention during the study period to prevent or treat visual loss that might result from that condition
• Any concurrent intraocular condition in the study eye that, in the opinion of the investigator, could cause an unwanted effect on treatment efficacy, compliance or require intraocular surgery (except for cataract surgery and YAG capsulotomy) during the study period
• Presence of corneal decompensation, haze or scarring with an impact on BCVA
• Refractive error larger than 6 diopters. In case of pseudophakia or refractive surgery: History of refractive error larger than 6 diopters.
• Intake of drugs known to cause retinal toxicity (e.g. hydroxychloroquine or tamoxifen)
• Presence of active macular neovascularization at baseline

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To characterise and quantify focal and global changes of the retina by retinal imaging to identify patients at risk for conversion to advanced AMD.	The correlation between biomarkers (independent variables) and progression will be assessed by linear mixed models or prospectively by Cox-regression models. Artificial intelligence models will be applied to assess progression speed and predict local and global progression. Mixed Effects models will be calculated to estimate the association between independent variables, including the timepoint as an independent variable, on individual markers of progression (PR thinning and PR loss expansion).	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To identify and quantify disease progression-related biomarkers	Longitudinal assessments of imaging biomarkers are performed in a descriptive manner. The following biomarkers will be evaluated in detail as independent variables: Drusen volume/Refractile drusen (scale, nl); Subretinal Drusenoid Deposits (SDD) (scale, mm2); Hyperreflective Foci (HRF) (scale, nl); Thinning of outer retinal layers (PR thinning) (scale, µm); Loss of outer retinal layers (RPE and PR) (scale, mm2); PR loss/RPE loss ratio (scale, ratio); Other retinal biomarkers if relevant to the progression of intermediate AMD to advanced AMD The correlation between biomarkers (independent variables) and disease progression will be assessed by linear mixed models or prospectively by Cox-regression models. Mixed Effects models will be calculated to estimate the association between independent variables, including the timepoint as an independent variable, on individual markers of progression (PR thinning and PR loss expansion).	2 years
To evaluate monitoring of AMD progression assisted by AI algorithms	The following will be provided by AI-based image analysis of the GA Monitor (independent variables used to detect an event for the Cox-regression model): RPE integrity loss (mm2) in the 1mm central area, 6mm area, and the respective relative change to previous visit; PR integrity loss (mm2) in the 1mm central area, 6mm area, and the respective relative change to previous visit The following will be provided by AI-based image analysis of the Fluid Monitor (independent variables used to detect an event for the Cox-regression model): Intraretinal fluid volume (nl) in the 1mm central area, 6 mm area, and the respective relative change to previous visit; Subretinal fluid volume (nl) in the 1mm central area, 6 mm area, and the respective relative change to previous visit; Pigment epithelium detachment volume (nl) in the 1mm central area, 6mm area, and the respective relative change to previous visit	2 years

Collaborators and Investigators

• Sponsor: Medical University of Vienna
• Collaborators: University of Zurich; Centre Hospitalier Universitaire Dijon; Fundacion Clinic per a la Recerca Biomédica; Queen's University, Belfast; University Medical Centre Ljubljana; Vista Klinik

Study record dates

Study Major Dates

• Study Start (Actual): February 25, 2025
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): July 1, 2027

Study Registration Dates

• First Submitted: April 2, 2024
• First Submitted That Met QC Criteria: April 2, 2024
• First Posted (Actual): April 8, 2024

Study Record Updates

• Last Update Posted (Actual): May 15, 2025
• Last Update Submitted That Met QC Criteria: May 12, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Eye Diseases; Retinal Diseases; Retinal Degeneration; Disease Progression; Macular Degeneration
• Other Study ID Numbers: 1109/2024

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No