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Visual Loss in Geographic Atrophy
TAKE-HOME MESSAGE
- This retrospective analysis of the results of several trials involving patients with geographic atrophy (GA) secondary to age-related macular degeneration showed no correlation between baseline best-corrected visual acuity (BCVA) and GA lesion area. The type of GA lesion was correlated with the rate of BCVA loss. Specifically, unifocal lesions were associated with a (marginally) faster rate of BCVA loss compared with multifocal lesions, and nonsubfoveal unifocal lesions were associated with the fastest rate of vision loss over time.
- This study underscores the influence of focality, foveal involvement, and GA growth rate on the risk of vision loss over time.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To assess the correlation of lesion growth rate and baseline factors, including foveal involvement and focality, on visual loss as measured by best-corrected visual acuity (BCVA) in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD).
DESIGN
Retrospective analysis of the lampalizumab phase 3 (NCT02247479 and NCT02247531) and prospective observational (NCT02479386) trials.
PARTICIPANTS
Patients with bilateral GA.
METHODS
Monthly BCVA and fundus autofluorescence (FAF) at baseline and every 6 months for 2 years were analyzed. Baseline GA area from FAF images was correlated to baseline BCVA and change in BCVA. The lesion growth rate was calculated as the slope of a linear fit from all available GA area measurements of a patient. Association between GA growth rate quartiles and BCVA changes were assessed, subgrouped by GA foveal involvement and/or focality. Time-to-event analysis for BCVA loss of ≥ 5, ≥ 10, and ≥15 letters was performed. A Cox regression model adjusted for baseline factors was performed on these outcomes. Kaplan-Meier (KM) curves are provided for each baseline factor and GA growth rate.
MAIN OUTCOME MEASURES
Correlations of baseline BCVA, GA area, and growth rate with change in BCVA, and time to ≥ 5, ≥ 10, and ≥ 15-letter loss by foveal involvement and/or focality.
RESULTS
BCVA and GA area at baseline did not correlate with BCVA change at any visit. GA growth rate showed a weak correlation with BCVA loss, which increased over time. The 2 highest GA growth rate quartiles had accelerated BCVA loss in eyes with subfoveal, unifocal lesions. Approximately 75%, 50%, and 25% of study eyes experienced a ≥ 5-, ≥ 10-, and ≥ 15-letter loss by 2 years, respectively.
CONCLUSIONS
BCVA and GA area at baseline did not correlate with BCVA loss, but faster GA growth rates appeared to be associated with faster BCVA loss. GA foveal involvement and focality correlated with the rate of BCVA loss with subfoveal lesions at high risk of vision loss over time, especially when the GA lesion was unifocal.
Additional Info
Visual Loss in Geographic Atrophy: Learnings From the Lampalizumab Trials
Ophthalmology 2024 Nov 22;[EPub Ahead of Print], N Anegondi, V Steffen, SR Sadda, S Schmitz-Valckenberg, A Tufail, K Csaky, EM Lad, PK Kaiser, D Ferrara, U ChakravarthyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Anegondi and co-authors conducted a retrospective analysis of the data collected from three previous prospective trials, including two unsuccessful lampalizumab phase III trials and one prospective observational study on geographic atrophy (GA). The current study analyzed the collected data from the above-mentioned trials using "simple approaches" — that is, measurement of best-corrected visual acuity and fundus autofluorescence — but could not be "simpler," revealing important clinical correlations of GA growth rate and baseline factors such as foveal involvement and focality with visual loss in patients with GA. Furthermore, the analyzed results showed that faster GA growth rates appeared to be associated with faster best-corrected visual acuity loss. The current analysis also demonstrated that GA foveal involvement and single focality were risk factors for vision loss over time.
These current data have led us to a better understanding of the natural course of GA. However, notably, the current dataset was mainly constituted of patients who had been enrolled in previous lampalizumab trials, specifically the dataset after an intervention for GA. Therefore, whether the GA growth rate and vision loss in this cohort completely represented the patients' natural history requires further validation.