Geographic Atrophy Location, Acuity Affect Vision-Related Quality of Life in Patients with AMD

Sandrine Künzel

Credit: University of Bonn

Findings from a recent study are providing clinicians with an overview of the influence of structural and functional parameters on the vision-related quality of life in patients with geographic atrophy (GA) secondary to age-related macular degeneration.

Subfields of the better eye, namely the inner lower and inner left, had a greater association with vision-related quality of life than those of the worse eye. Among foveal-sparing patients, low-luminance visual acuity of the better eye had the most notable impact on all vision-related quality of life scales.¹

“The yet uncertain risk-benefit ratio of [pegcetacoplan and avacincaptad pegol] in clinical practice underscores the need for criteria to distinguish patients who may benefit from these novel therapeutic strategies from patients for whom these invasive, risk-associated interventions are highly unlikely to significantly affect their quality of life in a positive way,” wrote investigators.¹ “Our study investigates the relevance of a variety of GA determinants to [vision-related quality of life] to aid clinicians in making this determination.”

The most common cause of severe loss of eyesight among people aged 50 years and older, age-related macular degeneration affects central vision and the ability to see fine details.² About 20% of people who have age-related macular degeneration also have GA, which leads to further loss of central vision.³ Although medications for GA have emerged in recent years, questions regarding the quality of life among these patients and the ability of treatment to change it remain unanswered.

Sandrine Künzel, of the department of ophthalmology at the University of Bonn in Germany, and colleagues sought to assess the impact of structural and functional parameters on vision-related quality of life by examining the association between GA location, best-corrected visual acuity, low-luminance visual acuity, reading acuity, and speed with responses to the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25). Investigators enrolled patients > 55 years of age with GA in both eyes from the University Eye Hospital in Bonn, Germany. Patients with exudative neovascular age-related macular degeneration or any other ocular disease potentially affecting the assessment of the retina in the study eye were excluded.¹

In total, 164 eyes from 82 participants with GA were included in the study. The cohort consisted of 43 females and 39 males with a mean age of 77.2 (Standard deviation [SD], 7.5) years at baseline. The mean area of GA was 2.9 (SD, 1.2) mm2 for the better eye and 3.1 (SD, 1.3) mm2 for the worse eye. The median NEI-VFQ-25 composite score was 70 (interquartile range [IQR], 25).¹

Upon analysis, subfields of the better eye, defined based on best-corrected visual acuity, were more greatly associated with vision-related quality of life than those of the worse eye. Across composite and subscale scores, the inner lower and inner left subfields were the most relevant, which retained significance in the multivariate analysis. For the composite score, the next most important subfields were the outer lower subfields of the better eye and the inner lower subfield of the worse eye, which were also significant in the multivariate analysis.¹

For the near activities subscale, the inner left subfield of the worse eye was the most relevant. For the distance activities subscale, these included the inner lower subfield and inner right subfield of the worse eye. Investigators pointed out when all structural determinants were added, the inner lower and inner left subfields of the better eye again emerged as most relevant in the univariate analysis and remained relevant in the multivariate analysis.¹

Foveal-sparing GA of the better and worse eye were among the least relevant variables to composite and distance activities scores, but foveal-sparing demonstrated greater salience for near activities in the univariate analysis and was the strongest contributor to the multivariate analysis. For the distance activities scale, the most relevant determinants were the inner lower and inner right subfields of the worse eye.¹

In the univariate regression with visual function variables, low luminance visual acuity of the better eye was the most salient factor for the composite scale. For the near activities scale, best-corrected visual acuity, reading acuity, and the inner left subfield of the better eye were most relevant. For the distance activities scale, the inner lower subfield, low luminance visual acuity, inner left subfield, and reading speed of the better eye were greatly associated.¹

Investigators separately assessed 86 eyes from 43 participants with foveal-sparing GA. The univariate regression with only Early Treatment Diabetic Retinopathy Study subfields demonstrated the influence of the inner lower subfield of the better eye to composite and distance activities scores, as well as the inner left subfield of the better eye to near activities scores. In the univariate regression with all variables, low luminance visual acuity of the better eye again showed the greatest relevance and emerged as significant for both the near activity and distance activity subscales in the foveal-sparing cohort.¹

“This study demonstrates the relative value of structural and functional GA markers to VRQoL. The inner left and inner lower subfields were most relevant for near activities and distance activities, respectively. Of the functional markers, LLVA was a notable contributor within the analysis. These findings can inform treatment decisions in regards to recently approved interventions for GA secondary to AMD,” concluded investigators.¹

References:

1. Künzel SH, Broadbent E, Möller PT, et al. Impact of lesion location and functional parameters on vision-related quality of life in geographic atrophy secondary to AMD. Preprint. medRxiv. 2023;2023.09.22.23295946. Published 2023 Sep 23. doi:10.1101/2023.09.22.23295946
2. Johns Hopkins Medicine. Age-Related Macular Degeneration (AMD). Conditions and Diseases. Accessed October 24, 2023. https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd
3. Cleveland Clinic. Geographic Atrophy. Diseases & Conditions. April 5, 2023. Accessed October 24, 2023. https://my.clevelandclinic.org/health/diseases/24890-geographic-atrophy