{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:32:36Z","timestamp":1760574756150,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"United States National Institutes of Health","doi-asserted-by":"publisher","award":["T32EY024236"],"award-info":[{"award-number":["T32EY024236"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Optical coherence tomography (OCT)-reflective drusen substructures (ODSs) are associated with the conversion of intermediate AMD to geographic atrophy (GA). However, ODSs must be manually identified, a laborious process introducing bias and variation. This study proposes objective radiomic metrics of drusen phenotypes and validates them for the prediction of GA development and GA growth rate. Methods: A total of 104 drusen with high-reflective cores (H-type), 105 with low-reflective cores (L-type), 129 conical drusen (C-type), and 101 normal drusen (N-type) were segmented from OCT images. Radiomic features were extracted from these drusen, and the most important features for drusen classification were extracted from the retinal pigment epithelium\u2013Bruch\u2019s membrane compartment of 743 OCT scans of eyes with dry AMD and used to predict GA conversion and fast growth. Results: Radiomic features classified drusen phenotypes with AUC = 0.87\u20130.95. H-type drusen have a higher reflectivity, greater variation in reflectivity, and coarser texture (p &lt; 0.001). L-type drusen have a lower reflectivity and greater variation in reflectivity (p &lt; 0.0001). C-type drusen have a less spherical shape and more disordered internal reflectivity (p &lt; 0.001). N-type drusen have a more spherical shape and more uniform internal reflectivity (p &lt; 0.001). These radiomic features predict the conversion from intermediate AMD to GA and top-quartile GA growth rate with AUC = 0.59\u20130.74 at years 1\u20133. Conclusions: These results demonstrate the potential of clinical phenotype-grounded radiomics for objective automated drusen analysis, GA risk stratification, and clinical prediction.<\/jats:p>","DOI":"10.3390\/diagnostics15202594","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T08:34:26Z","timestamp":1760517266000},"page":"2594","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiomic Characterization and Automated Classification of Drusen Substructure Phenotype Associated with High-Risk Dry Age-Related Macular Degeneration"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6197-9476","authenticated-orcid":false,"given":"Scott W.","family":"Perkins","sequence":"first","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA"},{"name":"The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal","family":"Shah","sequence":"additional","affiliation":[{"name":"The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Whitney","sequence":"additional","affiliation":[{"name":"The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2009-6487","authenticated-orcid":false,"given":"Karen","family":"Matar","sequence":"additional","affiliation":[{"name":"The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3827-4915","authenticated-orcid":false,"given":"Hannah J.","family":"Yu","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Houston, TX 77090, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-5091","authenticated-orcid":false,"given":"Charles C.","family":"Wykoff","sequence":"additional","affiliation":[{"name":"Retina Consultants of Texas, Houston, TX 77090, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6763-7768","authenticated-orcid":false,"given":"Justis P.","family":"Ehlers","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA"},{"name":"The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA"},{"name":"Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/ceo.14294","article-title":"Treatment of Dry Age-Related Macular Degeneration: A Review","volume":"51","author":"Girgis","year":"2023","journal-title":"Clin. 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