Geographic Atrophy Progression Trends Observed in AMD

Geographic atrophy progression may involve visual acuity decline, subfoveal involvement, and new onset neovascularization in patients with age-related macular degeneration (AMD), according to research published in Ophthalmology Science.

Researchers sourced data from the Intelligent Research in Sight (IRIS) registry and included 69,441 patients with geographic atrophy secondary to AMD in the retrospective analysis. The team stratified participants according to geographic atrophy status into 1 of 2 groups, which consisted of individuals with bilateral geographic atrophy (n=44,20; mean age, 81.38 years; 67% women) or patients with geographic atrophy and neovascular AMD in the contralateral eye (n=25,321; mean age, 82.58 years; 67% women). Study participants underwent assessments of visual acuity changes, instances of new onset neovascularization, and geographic atrophy progression to subfoveal involvement during a 24-month or longer follow-up period.

Among patients with bilateral geographic atrophy, 14% had a visual acuity of 20/20 or better and 17 had a visual acuity of 20/100 or worse. These values were 8% and 28%, respectively, in individuals with geographic atrophy and fellow eye neovascular AMD.

Stratified according to subfoveal and nonsubfoveal involvement, patients with subfoveal involvement had worse visual acuity compared with patients with nonsubfoveal involvement among both the bilateral geographic atrophy cohort (mean, 58.98 vs 67.45 ETDRS letters) and the group with fellow eye neovascular AMD (mean, 46.86 vs 65.69 ETDRS letters).

Geographic atrophy progression from nonsubfoveal to subfoveal involvement occurred in 16.7% and 12.5% of individuals with baseline nonsubfoveal involvement in the bilateral geographic atrophy (n=2608) and fellow eye neovascular AMD groups (n=3605), respectively. The average time to progression ranged between 72.6 to 73.6 weeks for individuals with bilateral geographic atrophy and between 66.9 to 70.0 weeks for participants with fellow eye neovascular AMD.

While these outcomes may discourage patients who are susceptible to geographic atrophy progression from adhering to follow-up care regimens, the researchers argue that such care is crucial among these individuals.

“Patients with vision loss due to [geographic atrophy] may not perceive a benefit to following up with their eyecare provider if they have been informed about the lack of treatment options and the irreversible nature of lesion growth,” according to the study authors. “The results of this study highlight the need for patient education and the importance of follow up in [geographic atrophy], for adequate and ongoing monitoring and vision support, and to identify and treat ocular comorbidities.”

Study limitations include a retrospective nature, potential documentation errors in the large-scale registry, and an inability to examine geographic atrophy progression through clinical images.

Disclosure: This research was supported by Apellis Pharmaceuticals, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.