Three-Year Clinical Outcomes in Geographic Atrophy: An Analysis of 18,712 Patient Eyes

Abstract

Methods: Retrospective analysis of 18,712 eyes with GA using the CorEvitas Vestrum Health Retina Database. Results: Mean age at index was 78.6 years (SD = 7.9) and mean visual acuity (VA) was 67.5 letters (SD = 13.0, Snellen equivalent 20/45). 18.9% of eyes developed nAMD within 36 months. Eyes with fellow-eye nAMD developed nAMD at over twice the rate of eyes with fellow-eye GA (relative risk 2.34, 95% CI [2.20, 2.49]). Mean VA of eyes that did not develop nAMD declined by 12.4 letters (95% CI [12.0, 12.9]) within 36 months. Older age and moderate baseline visual impairment (VA < 20/40 to 20/100) independently correlated with accelerated rate of decline. Eyes of patients in the oldest quartile with moderate visual impairment experienced the worst outcomes, losing an average of 19.7 letters over 36 months (95% CI [18.1, 21.3]). By 36 months, 70% of eyes had vision below threshold for driving (VA ≤ 20/40), 42% had low vision (VA ≤ 20/70), and 23% were legally blind (VA ≤ 20/200). Conclusions: GA is associated with significant disease burden. Eyes with GA lose an average of two to three lines of VA within 36 months of follow up. Older age and moderate baseline visual impairment independently correlate with poorer visual outcomes. Presence of nAMD in the fellow eye is associated with twofold higher risk of exudative conversion within 36 months.