Macular Atrophy Progresses Similarly in Wet and Dry AMD Types

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Macular atrophy in eyes with neovascular (wet) age-related macular degeneration (nAMD) exhibited comparable progression and morphologic characteristics as geographic atrophy (GA) in fellow eyes with dry AMD, according to data presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting.¹

“We found that both AMD groups displayed comparable mean atrophy growth rate per year, similar foveal involvement and unifocal configuration of atrophy, and the presence of intraretinal hyperreflective foci and reticular pseudodrusen,” said Hana A. Mansour, MD, Mid Atlantic Retina, Wills Eye Hospital.²

The single-center, retrospective cross-sectional study reviewed patients with bilateral atrophy secondary to AMD between January 2010 and August 2023.¹ Mansour and colleagues sought to compare these patients’ natural history and anatomical characteristics of atrophy.

Data were recorded at two follow-up clinic visits, one year apart, and independent graders measured the atrophy size and graded according to the Consensus on Atrophy Meeting (CAM) group criteria. A square root transformation (SQRT) was conducted to determine the change in atrophy size (mm²).

A total of 8403 patients with bilateral AMD were screened for inclusion. Overall, 208 eyes of 104 patients were included for analysis, including 104 eyes with dry AMD and 104 fellow eyes with nAMD. Patients had an average age of 87.5 years, 68.3% were female, and 31.7% were male.

At the first clinic visit, the average atrophy size was 14.05 mm2 in eyes with dry AMD and 14.14 mm² in eyes with nAMD (P = .95). By the second clinic visit, the mean atrophy size was 16.92 mm² in eyes with dry AMD and 17.35 mm² in eyes with nAMD (P = .78).

After assessing the mean atrophy growth rate per year, eyes with nAMD experienced a growth rate of 3.08 ± 2.52 mm² per year, compared with 2.77 ± 1.88 mm² per year in eyes with dry AMD (P = .32).

Atrophy progression was also measured using the SQRT. At the first clinic visit, the average atrophy size was 3.51 mm and 3.55 mm in eyes with dry AMD and nAMD, respectively (P = .83). By the second clinic visit, the rates were 3.90 mm and 3.96 mm in the dry AMD and nAMD cohorts, respectively (P = .74).

The mean growth rate of SQRT area of atrophy per year was 0.40 mm per year in eyes with nAMD and 0.38 mm per year in eyes with dry AMD (P = .55).

Approximately 89% and 94% of eyes with dry AMD and nAMD, respectively, experienced foveal involvement at the first clinic visit (P = .21), rising to 90% and 96% at the second clinic visit (P = .10). Similarly, 51% and 48% of these cohorts experienced unifocal configuration of atrophy at the first clinic visit (P = .68), remaining at 52% and 49% by the second clinic visit (P = .68).

Rates of intraretinal hyperreflective foci were 68% and 76% for the dry AMD and nAMD cohorts at the first clinic visit (P = .28) and 69% and 78% at the second visit (P = .21). The presence of reticular pseudo drusen was 94% and 98% for these cohorts at the first visit (P = .12) and 96% and 98% at the second visit (P = .52).

Due to the similarities between the mechanism of action of atrophy development, Mansour and colleagues indicated these data may support future clinical trials investigating GA therapies in eyes with nAMD and atrophy.

“The mechanism of atrophy development might be similar in dry AMD and nAMD, which may support a rationale for conducting clinical trials using GA therapies in eyes with nAMD and atrophy,” Mansour and colleagues wrote.

Reference

1. _{Mansour H. Atrophy Growth Rates in Neovascular Age-Related Macular Degeneration Compared to Fellow Eyes With Dry Age-Related Macular Degeneration. Poster presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting. Stockholm, Sweden. July 17-20, 2024.}
2. _{The American Society of Retina Specialists. 2024 Top 10 Poster Award Winners. The American Society of Retina Specialists. Accessed July 29, 2024. https://www.asrs.org/clinical/clinical-and-surgical-videos/updates-from-the-field-video-interviews-with-experts-at-key-retina-meetings/2024-top-10-poster-award-winners.}