Markers of disease progression in atrophic AMD

Abstract

AbstractGeographic Atrophy (GA) is a common cause for severe visual loss in age‐related macular degeneration (AMD). In contrast to neovascular AMD in which efficient therapy is now available with intravitreally administered inhibitors of VEGF, there is as yet no therapy available for patients with GA. Natural history studies have demonstrated a continuous progression of outer retinal atrophy in patients with GA. Hereby, a high interindividual variability has been documented with regard to enlargement rates of GA ptaches over time. Various markers of disease progression have been identified including phenotypic charatersitcs on fundus photographs such as soft drusen and hyperpigmentary changes. Furthermore, certain abnormal patterns of increased fundus autofluorescence (FAF) on confocal SLO images have been shown to represent risk characteristics for GA evolution and aloow disrimintaion of slow vs. fast progressors. The status of the fellow also has an imapct on progression rates. SD‐OCT imaging is currently evaluated in ongoing longitudinal studies with respect to specific microstructural alterations in the junctional zone of GA and their impactz for future progression. Idenfication of progrnostic markers is not o9nly important for a better understandibng of the disease process, but also for the design and conduct of interventional clinical trials in patients with GA as enrichment for fast progressors allows to perform such trials in an acceptable time period in a relatively slowly progressing disease, to reduce costs for clinical developments and to increase the likelyhood for the identification of a therapeutic signal.