Geographic atrophy secondary to age-related macular degeneration: Significance of lesion location and functional determinants to vision-related quality of life

Abstract

Purpose : The primary objective of our study was to quantify the impact of geographic atrophy (GA) secondary to age-related macular degeneration on vision-related quality of life (VRQoL). Recognizing the limitations of traditional biomarkers like lesion size and best-corrected visual acuity (BCVA), our research utilizes patient-reported outcomes to understand how GA characteristics affect daily living. We aim to determine which parameters of GA, including lesion location and visual function parameters, are most influential in shaping VRQoL.

Methods : This was a prospective, non-interventional, natural history study of 82 patients with bilateral GA. Lesion size and location was determined using the Early Treatment Diabetic Retinopathy (ETDRS) grid subfields aligned to the fundus autofluorescence image, BCVA, low-luminance visual acuity (LLVA), reading acuity, and reading speed. VRQoL was measured using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25), which includes subscales for near and distance activities. We applied linear mixed-effects models with the least absolute shrinkage and selection operator for variable selection. Correlations of the GA parameters with VRQoL scores were applied for both the entire group and the subset with foveal-sparing GA.

Results : Participants had an average total GA area of 2.9 ± 1.2 mm² in the better eye (BE) and 3.1 ± 1.3 mm² in the worse eye (WE). LLVA emerged as the most salient factor for the composite VRQoL score. The inner lower subfield of the BE had the strongest association with the distance activities subscale, while the inner left subfield of the BE was most highly associated with near activities (Figure 1). For participants with foveal-sparing GA, LLVA of the better eye was the most important variable across all VRQoL scales.

Conclusions : Our study found that the inner lower and inner left subfields of the BE are key for VRQoL. For foveal-sparing patients, LLVA emerged as an important factor. Recent approval of drugs to slow the progression of GA makes it increasingly critical to understand how GA characteristics influence VRQoL. Our findings highlight the value of targeted assessments of GA lesion location and visual function in optimizing treatment strategies.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure 1. Univariate regression of functional determinants, structural determinants, and ETDRS subfields with VRQoL.