Pathways to Geographic Atrophy in Non-Neovascular Age-Related Macular Degeneration.

Abstract

This study aimed to characterize and quantify the precursor lesions of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD). A retrospective study of eyes with a minimum 6-month follow-up prior to developing GA. Evaluations included color and autofluorescence imaging, along with spectral domain optical coherence tomography, employing definitions from the Consensus of Atrophy Meeting Group and Consensus on Neovascular Age-Related Macular Degeneration Nomenclature Study Group. There were 55 eyes of 44 patients, who had a mean age of 81.3 years at onset of atrophy; 35 (63.6%) were female. The mean duration of follow-up before and after the advent of GA was 4.9 years and 1.2 years, respectively. GA was preceded by collapse of a druse in 41 (74.5%) of eyes. Of these 29 (70.7%) were drusenoid pigment epithelial detachments. Among the eyes with regressing drusen, there were 9 with overlying vitelliform deposit, and all had concurrent subretinal drusenoid deposit (SDD), while 19 of 30 eyes with no vitelliform deposit overlying the druse had concurrent SDD, a difference that was significant (P<.001). Regression of SDD was found in 3 (5.4%) eyes, regression of vitelliform deposit associated with SDD in 6 (7.3%), and regression of vitelliform deposit in eyes concurrently harboring drusen was found in 3 (5.4%) at the site of eventual development of GA. GA appears to develop from multiple pathways as manifested by the many precursor lesions, all various forms of extracellular deposit, that upon regression, result in a common end stage appearance.