Progression of Geographic Atrophy: Epistemic Uncertainties Affecting Mathematical Models and Machine Learning

Suspension of Anti-VEGF Treatment Does Not Affect Expansion of RPE Atrophy in Neovascular Age-Related Macular Degeneration

PURPOSE

To determine whether atrophy of the retinal pigment epithelium (RPE) in eyes with neovascular age-related macular degeneration (nAMD), which meets the criteria for the suspension of anti-vascular endothelial growth factor (anti-VEGF) treatment, is associated with anti-VEGF treatments.

METHODS

Twelve eyes of 12 patients with nAMD who began anti-VEGF treatment and were followed for 1 year after meeting the criteria for the suspension of anti-VEGF were studied. Six eyes of six patients were placed in the continuation group, and six eyes of six patients were placed in the suspension group. The RPE atrophic area at the time of the last anti-VEGF treatment was set as the baseline size and that at 12 months after the baseline (Month 12) was taken as the final size. A comparison of the expansion rate of RPE atrophy between the two groups was made by the square-root transformed differences.

RESULTS

The expansion rate of atrophy was 0.55 (0.43, 0.72) mm/year in the continuation group and 0.33 (0.15, 0.41) mm/year in the suspension group. This difference was not significant. (p = 0.29).

CONCLUSIONS

Suspension of anti-VEGF treatments in eyes with nAMD does not alter the expansion rate of RPE atrophy.

Epistemic Uncertainties in the Assessment of Regional Soil Acidification

The increasing acidification of soil due to pollution and agricultural management practices is a growing problem worldwide, where food production is already under threat by climate change, more frequent droughts, and soil nutrient depletion. Soil acidification is quantified by pH measurements and is a primary metric for soil health. High soil acidity is a constraint on the production of grains and other crops because it decreases the bioavailability of important plant nutrients while increasing soil toxicity arising from an imbalance of essential soil elements. Field pH can be estimated by colour test kits which are very cost-effective and particularly suitable for developing countries where laboratory services are not available or fail to provide timely results. Because the pH test kit is based on visual colour matching between a colour card scale and a soil sample in solution, there are epistemic uncertainties, such as variability in expert opinion, differences in colour vision, measurement error, instrumentation, and changes in daylight spectral content. In this study, expert human observers were compared in experiments conducted using a standard pH test kit under a range of environmental conditions. A significant difference in uncertainty in colour discrimination was evident between male and female experts, whereas changes in daylight conditions had lower impact on the variance of pH estimates. In a group of subject matter experts, the male standard error (0.35 pH) was 57% higher on average over the range of pH values (pH = 4 → 10) compared to females (0.22 pH). This error was largest (70%) in the low pH 4 to 6.5 range, which is a critical range for successful amelioration of soil acidification. The results suggest that historical database measurements may have hitherto unrecognised uncertainties that affect confidence intervals for experimental data that in turn will have an impact on predictive models and policy development.