Geographic atrophy in AMD ‐ prognostic factors based on long‐term follow‐up

Abstract

AbstractPurpose: So far, the natural course of geographic atrophy (GA) progression in age‐related macular degeneration (AMD) has primarily been investigated by colour fundus photography (CF) and fundus autofluorescence (FAF) imaging. The aim of this long‐term retrospective, observational clinical study was to show the enlargement rate (ER) of GA, defined as complete retinal pigment epithelium and outer retinal atrophy (cRORA) and to find predictors of progression.Methods: All patients available in the database of Vista Augenklinik Binningen, Switzerland, with follow‐up of at least 24 months and existing GA in at least one eye, regardless of neovascular AMD (nAMD) being present initially or in the course of disease, were included. SD‐OCT and FAF evaluations were performed according to a standardized protocol. The cRORA area ER (mm2/year), the cRORA square root area ER (mm/yr), the FAF GA area and the condition of the outer retina (inner−/outer segment (IS/OS) and external limiting membrane (ELM) disruption scores) were determined.Results: 204 eyes of 129 patients (64% females) were included. Mean follow‐up time was 4.2 ± 2.2 (range 2–10) years. 109 of 204 (53.4%) eyes were classified as wet AMD (neovascular aspect being present initially or in the course of disease), 95 of 204 (46.6%) eyes were classified as exclusively dry AMD. The primary lesion was unifocal in 146 (72%) eyes and multifocal in 58 (28%) eyes. A strong correlation was observed between the area of cRORA (SD‐OCT) and the FAF GA area (r = 0.924; p < 0.001). Mean ER was 1.44 ± 1.2 mm2/year and mean square root ER 0.29 ± 0.19 mm/year. There was no significant difference in mean ER between eyes without (dry AMD) and with intravitreal anti‐VEGF injections (nAMD) (0.30 ± 0.19 mm/year vs. 0.28 ± 0.20 mm/year; p = 0.466). Eyes with a multifocal atrophy pattern at baseline (n = 58) had a significantly higher mean ER compared to eyes with a unifocal pattern (0.34 ± 0.19 mm/year vs. 0.27 ± 1.19 mm/year; p = 0.008). There were moderate significant correlations between ELM and IS/OS disruption scores and visual acuity at baseline, 5 and 7 years (all r values ca. −0.5; p < 0.001).Conclusions: SD‐OCT evaluated cRORA area might serve as a GA parameter comparable to traditional FAF measurement. The dispersion pattern might be a predictor of ER, whereas anti‐VEGF treatment seems not to be associated with ER.