Abstract
Purpose :
Vision-related quality of life (VRQoL) is a patient-centered metric that is utilized to examine the impact of geographic atrophy (GA) in patients with age-related macular degeneration (AMD). However, little is known about the relationship between VRQoL and functional and structural GA biomarkers such as lesion area, and prior work has not accounted for GA lesion location. Thus, we examined the influence of the topographic distribution of GA on VRQoL.
Methods :
We manually segmented GA lesions on color fundus photographs of 161 Age-Related Eye Disease Study (AREDS) participants with nonexudative AMD. For each participant, we calculated the total area of atrophy in the better eye (eye with least atrophy) and the worse eye (eye with most atrophy), as well as the area of atrophy in each of the nine subfields of the Early Treatment for Diabetic Retinopathy Study (ETDRS) grid for each eye. VRQoL had been measured using the National Eye Institute Visual Function Questionnaire (NEI-VFQ). We assessed associations between VRQoL and area of atrophy in each topographic region of the better and worse eye utilizing linear mixed-effects models while controlling for age, gender, and the presence of bilateral disease.
Results :
There was no significant association between VRQoL and total area of atrophy in the better eye (β, -0.22; 95% confidence interval [CI], -0.84 to 0.40; p = 0.49) or worse eye (β, -0.27; 95% CI, -0.73 to 0.19; p = 0.25). When examining the topographic distribution of GA in the better eye, lower VRQoL was significantly associated with greater area of atrophy in the central 1-mm-diameter zone (β, -3.65; 95% CI, -6.85 to -0.45; p = 0.026), but not with area of atrophy in any of the other eight ETDRS subfields. In the worse eye, VRQoL was not significantly associated with area of atrophy in any topographic subfield.
Conclusions :
In this cohort, area of atrophy in the central 1-mm-diameter zone of the better eye was the only measure of atrophy that was significantly associated with VRQoL. Although GA area in the worse eye is often used as a structural endpoint in clinical trials, this measure was not associated with VRQoL and, thus, may not fully capture the effects of disease progression or interventions on VRQoL in patients with GA secondary to nonexudative AMD.
This is a 2021 ARVO Annual Meeting abstract.