Change in Area of Geographic Atrophy in the Age-Related Eye Disease Study

Abstract

Objective: To characterize progression of geographic atrophy (GA) associated with age-related macular degeneration in AREDS as measured by digitized fundus photographs. Methods: Fundus photographs from 181 of 4757 AREDS participants with a GA area of at least 0.5 disc areas at baseline or from participants who developed bilateral GA during follow-up were scanned, digitized, and evaluated longitudinally. Geographic atrophy area was determined using planimetry. Rates of progression from noncentral to central GA and of vision loss following development of central GA included the entire AREDS cohort. Results: Median initial lesion size was 4.3 mm2. Average change in digital area of GA from baseline was 2.03 mm2 (standard error of the mean, 0.24 mm2) at 1 year, 3.78 mm2 (0.24 mm2) at 2 years, 5.93 mm2 (0.34 mm2) at 3 years, and 1.78 mm2 (0.086 mm2) per year overall. Median time to developing central GA after any GA diagnosis was 2.5 years (95% confidence interval, 2.0-3.0). Average visual acuity decreased by 3.7 letters at first documentation of central GA, and by 22 letters at year 5. Conclusions: Growth of GA area can be reliably measured using standard fundus photographs that are digitized and subsequently graded at a reading center. Development of GA is associated with subsequent further growth of GA, development of central GA, and loss in central vision.

Modeling Visual Acuity in Geographic Atrophy Secondary to Age-Related Macular Degeneration

“…Data on the course of VA per se are important to assess visual impairment and progression over time. The obtained data on VA within the FAM study as reported herein are overall in accordance with the previous data published by others groups [17,20]. For example, the rates in the report by Sunness and coworkers (n = 123 subjects) and the current study for a loss of ≥3 lines are 31 versus 34.2% by 2 years and 53 versus 47.2% by 4 years.…”

“…Furthermore, while focusing on lesion characteristics and epidemiological data, most reports on the natural history of GA have identified prognostic factors for lesion size enlargement over time. These include GA size at baseline, previous enlargement rates, status of the fellow eye, fundus autofluorescence (FAF) patterns, presence of outer retinal tubulations, presence of reticular pseudodrusen, as well as lesion focality [12,13,19,20,21,22,23,24]. Meanwhile, in various clinical studies, more experience in the detection and quantification of total lesion size and its progression over time has been obtained.…”

“…The AREDS (Age-Related Eye Disease Study) research group has reported on VA data in the subgroup of 181 participants with GA out of the large AREDS cohort [20]. Based on color fundus photography, they demonstrated a decline in VA once GA appeared in the central macula [20].…”

“…Based on color fundus photography, they demonstrated a decline in VA once GA appeared in the central macula [20]. …”

Geographic Atrophy Progression in Eyes with Age-Related Macular Degeneration: Role of Fundus Autofluorescence Patterns, Fellow Eye and Baseline Atrophy Area

“…Previous histopathological studies have shown cell death of the retinal pigment epithelium (RPE), the outer neurosensory retina and the choriocapillaris in areas of GA. Multiple lines of experimental and clinical evidence indicate that excessive accumulation of lipofuscin (LF) in postmitotic RPE cells plays a role in the pathogenesis of GA associated with AMD [9,10,11,12,13,14]. …”