June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Modeling Progression in Terms of Visual Loss in Geographic Atrophy Secondary to Age-related Macular Degeneration
Author Affiliations & Notes
  • Monika Fleckenstein
    Ophthalmology, University of Bonn, Bonn, Germany
  • Jennifer Nadal
    Institute of Biostatistics, University of Bonn, Bonn, Germany
  • Rolf Fimmers
    Institute of Biostatistics, University of Bonn, Bonn, Germany
  • Moritz Lindner
    Ophthalmology, University of Bonn, Bonn, Germany
  • Arno P Goebel
    Ophthalmology, University of Bonn, Bonn, Germany
  • Steffen Schmitz-Valckenberg
    Ophthalmology, University of Bonn, Bonn, Germany
  • Matthias Schmid
    Institute of Biostatistics, University of Bonn, Bonn, Germany
  • Frank G Holz
    Ophthalmology, University of Bonn, Bonn, Germany
  • Footnotes
    Commercial Relationships Monika Fleckenstein, Bayer (R), Genentech (F), Heidelberg Engineering (C), Heidelberg Engineering (F), Heidelberg Engineering (R), Novartis (R), Optos (F), Roche (R), US20140303013 A1 (P), Zeiss Meditec (F); Jennifer Nadal, None; Rolf Fimmers, None; Moritz Lindner, Genentech (F), Heidelberg Engineering (F), Optos (F), Zeiss Meditec (F); Arno Goebel, Heidelberg Engineering (F), Optos (F), Zeiss Meditec (F); Steffen Schmitz-Valckenberg, Allergan (F), Bayer (F), Bayer (R), Heidelberg Engineeing (F), Heidelberg Engineeing (R), Novartis (C), Novartis (F), Novartis (R), Optos (F), Optos (R), Roche (C), Roche (F), Zeiss Meditec (F); Matthias Schmid, None; Frank Holz, Acucela (C), Allergan (C), Bayer (C), Bayer (F), Boeringer Ingelheim (C), Genentech (F), Heidelberg Engineering (F), Merz (C), Novartis (C), Novartis (F), Optos (F), Zeiss Meditec (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2822. doi:
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      Monika Fleckenstein, Jennifer Nadal, Rolf Fimmers, Moritz Lindner, Arno P Goebel, Steffen Schmitz-Valckenberg, Matthias Schmid, Frank G Holz, ; Modeling Progression in Terms of Visual Loss in Geographic Atrophy Secondary to Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2822.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To analyze and model the disease progression in terms of visual acuity (VA) loss in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

 
Methods
 

A total of 226 eyes of 151 patients (63.6% women, mean age at baseline 74.0 ± 7.6 years; median follow-up time 808 days [IQR 940 days]) participating in the prospective natural history FAM (Fundus Autofluorescence in AMD)-Study with uni- or multifocal GA secondary to AMD and at least six months of serial standardized examinations were analyzed. Data assessment included ETDRS best-corrected central visual acuity, routine ophthalmological examination and confocal scanning laser ophthalmoscopy fundus autofluorescence (FAF) and infrared reflection imaging. Total size of atrophy was determined using semi-automated image analysis software. The course of VA was analyzed using a linear mixed-effects model with LogMAR as the response variable. Predictor variables included age at baseline, gender, time, GA size, diagnosis of the fellow eye, foveal involvement of GA, focality of the GA lesion and FAF pattern.

 
Results
 

At baseline, median VA was 0.5 [IQR 0.7] LogMAR. There was high variability of VA among patients and study eyes. Results from linear mixed model analysis suggested that approximately 65% of the variance of the LogMAR values could be explained by the assessed predictor variables. Variables with significant effect on VA (likelihood ratio tests) included time, with an estimated overall time trend of 0.029 units of LogMAR increase per year (p = 0.012) and GA size, with increase of the average LogMAR value by 0.06 units with each mm (square-root transformed values) (p < 0.001). Furthermore, age at baseline (increase of 0.00467 LogMAR units per year (p = 0.041)) and foveal involvement of GA (0.86 LogMAR units lower in eyes with definitively ‘spared fovea’ as compared to definitive foveal involvement (p<0.001)) had a significant effect on VA loss.

 
Conclusions
 

Variance of VA in eyes with GA secondary to AMD can be widely explained by known variables which include time, GA size, age at baseline and foveal involvement of GA. Modeling the course of VA with identification of influencing factors will help to estimate the patient specific disease progression and to better appraise potential therapeutic effects on VA in interventional trials on GA.

 
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