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Steffen Schmitz-Valckenberg, Monika Fleckenstein, Moritz Lindner, Arno P Goebel, Frank G Holz, FAM-Study Group; Long-term natural history of geographic atrophy in age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5888.
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To investigate the natural history of eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) with ≥ 4 years review period.
Fifty-seven eyes of 42 patients (median age at baseline 70.5 years, range 60.9 -84.4; median follow-up; 5.2 years, range 4.1 - 10.8) were identified in the FAM (Fundus autofluorescence in AMD)-study database for subjects with unilateral or bilateral GA at baseline in absence of any exudative AMD manifestation and with at least four years of serial standardized examinations. Data assessment included best-corrected central visual acuity (VA) measurements, routine ophthalmological examination and confocal scanning laser ophthalmoscopy including fundus autofluorescence. Total size of atrophy was determined using semi-automated image analysis software.
For all 57 eyes at baseline, the median VA was 0.4 logMAR (0 - 1.8) and the total GA size was 3.82 mm2 (0.13 - 15.14). During the entire observation period, the change of VA and the absolute enlargement of total GA size varied between -0.5 to 1.3 logMAR and 0.44 to 21.85 mm2, respectively. Change of VA and GA progression per year was 0.05 logMAR/year (-0.11 - 0.27) and 1.47 mm2/year (0.09 to 4.21). A ≥ 3 line visual acuity loss occurred in 27 eyes (47 %). In 4 patients with bilateral GA at baseline, development of secondary choroidal neovascularization during the review period was noted in one eye.
These findings are in accordance with a continuous enlargement of atrophic patches over time in patients with GA. A high variability in VA changes was noted partly reflecting foveal involvement over time. Long-term natural history data may be not only important for the design of novel therapeutic strategies, but also for interpretation of study outcomes in order to estimate possible benefits in future patient management.
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