Risk of Severe Visual Loss in Patients With Extrafoveal Geographic Atrophy Associated With AMD

Abstract

Purpose: : Severe visual loss in age–related macular degeneration (AMD) results either from choroidal neovascularization, pigment epithelial detachment or from geographic atrophy (GA). As part of the prospective multicenter natural history FAM study (Fundus Autofluorescence in age–related Macular Degeneration) we analysed progression and functional outcome in eyes with advanced extrafoveal geographic atrophy (GA) and good visual acuity at baseline.

Methods: : Patients with extrafoveal GA in four quadrants surrounding the foveola and ETDRS visual acuity of ≥20/32 at baseline were were analyzed. Examinations included ETDRS BCVA and FAF–imaging according to a standard operation procedure and using a confocal scanning laser ophthalmoscope (HRA, Heidelberg Engineering, Germany). Severe visual loss was defined as ≥6 ETDRS–lines loss.

Results: : 41 eyes of 37 patients (26 female, 11 male; mean age: 72.3 ± 6.8 years) met the criteria and were analyzed. Mean observation period was 22.0±13.3 months. 19 eyes (46.3%) showed a stable (± 1 ETDRS–line) visual acuity over time. In 7 eyes (17.1%) a 2 ETDRS–line loss was observed, while ten eyes (24.4%) showed a moderate loss of visual acuity of ≥3 ETDRS–lines. Five eyes (12.2%) suffered from severe visual loss of ≥6 ETDRS–lines during the review period.

Conclusions: : While areas of atrophy progress over time the results indicate that good visual acuity may be maintained over a long period in presence of advanced extrafoveal atrophy. The data are in accordance with the concept of foveal sparing and foveolar involvement not until late in the disease process. Data from the natural history study in this subset of patients with GA may be helpful to design future interventional trials.

Keywords: age-related macular degeneration • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)