Progression time to foveal loss in Geographic Atrophy

Abstract

Purpose : Geographic Atrophy (GA) is a prominent end stage of age-related macular degeneration (AMD) for which novel therapies are under development to reduce progression. We studied the long-term progression of GA and its relation to foveal involvement in a natural history study of non-selected cases.

Methods : The study population consisted of 62 eyes who had or developed GA in Rotterdam Study I, a population based prospective cohort which started in 1990 and which had follow up visits every five years. The location and surface area of GA was graded on fundus photographs and auto fluorescent images at every visit. We calculated the time until loss of RPE reached the fovea.

Results : Of the 62 eyes with GA and follow-up (range 1-12 years), 16 eyes had incident GA. At first presentation, 13 incident GA eyes had foveal sparing, and 3 eyes already had foveal involvement. Three eyes developed loss of RPE in the fovea during follow up. The average time until GA reached the fovea was 6.9 (SD 4.7) years. Of eyes (N=14) with prevalent non-foveal GA, time until foveal involvement was 5.5 years (SD 3.9). Most eyes (31/38) with foveal GA were visually impaired according to WHO definitions; this was not the case for non-foveal GA (9/22, p=0.001).

Conclusions : The first presentation of GA is mostly outside of the fovea, and the average time to reach the fovea is 5.8 years in persons who live long enough. Future trials for GA which aim to reduce the risk of foveal involvement should realize that this clinical endpoint takes a rather long time to develop.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.