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

Purpose: To analyze and model visual acuity (VA) in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Methods: The course of VA was analyzed using Turnbull's estimator in 226 eyes with uni- or bilateral GA due to AMD (151 patients; mean age 74.0 ± 7.6 years; mean follow-up time 33.4 ± 23.4 months) from the natural history FAM (Fundus-Autofluorescence Imaging in AMD) study. The variables ‘age at baseline', ‘gender', ‘lesion size', ‘diagnosis of the fellow eye', ‘status of the fovea', ‘focality of the lesion' and ‘pattern' were evaluated for effects on predicting VA using linear mixed-effects models. Results: Mean VA at baseline was 0.6 (Snellen 20/80) ± 0.4 logMAR [range -0.1 to 1.8 (20/17 to hand motions)], showing an estimated mean increase of 0.181 (95% CI 0.152-0.210) and 0.256 (0.214-0.300) after 2 and 4 years of follow-up, respectively. The percentage of eyes with a loss of ≥3 lines was 34% by 2 years and 47% by 4 years. Linear mixed model analysis suggested that 65% of VA variability could be explained by the assessed predictor variables. The strongest effect was found for the ‘status of the fovea' (0.69 logMAR units between ‘definitively spared fovea' and ‘definitive foveal involvement', p < 0.001). The second strongest effect was identified for ‘total lesion size' (effects between 0.02 and 0.09 logMAR units for each mm depending on foveal involvement, p < 0.001, square root transformed values). Conclusions: These findings underscore the importance of GA lesion characteristics as these have the strongest impact on VA. Natural history data and modeling VA to other variables will be helpful for refining outcome parameters and estimating possible benefits of therapeutic interventions.

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Outer retinal tubulation formation and clinical course of advanced age-related macular degeneration

Scientific Reports ◽

10.1038/s41598-021-94310-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alessandro Arrigo ◽

Emanuela Aragona ◽

Ottavia Battaglia ◽

Andrea Saladino ◽

Alessia Amato ◽

...

Keyword(s):

Macular Degeneration ◽

Müller Cells ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Advanced Age ◽

Age Related ◽

Dry Amd ◽

Foveal Sparing ◽

Wet Amd

AbstractOuter retinal tubulations (ORT) are a relatively new finding characterizing outer retinal atrophy. The main aim of the present study was to describe ORT development in advanced age-related macular degeneration (AMD) and to assess its relationship with disease’s severity. Patients with advanced AMD characterized either by macular neovascularization or geographic atrophy, showing signs of outer retinal disruption or retinal pigment epithelium atrophy on structural optical coherence tomography (OCT) at the inclusion examination were prospectively recruited. All the patients underwent complete ophthalmologic evaluation, structural OCT scans and fundus autofluorescence imaging. The planned follow-up was of 3-years. Main outcome measures were ORT prevalence, mechanism of ORT formation, mean time needed for complete ORT formation, best-corrected visual acuity (BCVA), definitely decreased autofluorescence (DDAF) area, questionably decreased autofluorescence (QDAF) area, retinal layer thickness, foveal sparing, number of intravitreal injections. We also assessed the possible role of external limiting membrane (ELM) and Müller cells in ORT pathogenesis. Seventy eyes (70 patients) were included; 43 showed dry AMD evolving to geographic atrophy, while 27 displayed the features of wet AMD. Baseline BCVA was 0.5 ± 0.5 LogMAR, decreasing to 0.9 ± 0.5 LogMAR at the 3-year follow-up (p < 0.01). We detected completely formed ORT in 26/70 eyes (37%), subdivided as follows: 20 eyes (77%) wet AMD and 6 eyes (23%) dry AMD (p < 0.01). ORT took 18 ± 8 months (range 3–35 months) to develop fully. We described the steps leading to ORT development, characterized by progressive involvement of, and damage to the photoreceptors, the ELM and the RPE. Eyes displaying ORT were associated with a smaller QDAF area, less retinal layers damage and lower rate of foveal sparing than eyes free of ORT (p < 0.01). We also described pigment accumulations simulating ORT, which were detected in 16/70 eyes (23%), associated with a greater loss of foveal sparing, increased DDAF area and smaller QDAF area at the 3-year follow-up (p < 0.01). In conclusion, this study provided a description of the steps leading to ORT development in AMD. ELM and Müller cells showed a role in ORT pathogenesis. Furthermore, we described a subtype of pigment hypertrophy mimicking ORT, evaluating its clinical utility.

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An overview of age-related macular degeneration and its management using external beam radiotherapy

Journal of Radiotherapy in Practice ◽

10.1017/s1460396999000023 ◽

1999 ◽

Vol 1 (1) ◽

pp. 3-9

Author(s):

John Newnham

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

External Beam Radiotherapy ◽

Age Related Macular Degeneration ◽

Western World ◽

Rapid Progression ◽

External Beam ◽

Age Related ◽

Radiation Induced

This paper aims to provide an overview of age related macular degeneration (ARMD) and its radiotherapy management.ARMD is already the leading cause of adult blindness in the western world. The neovascular form of ARMD is responsible for some 85% of blindness caused by ARMD as a whole. Its aetiology is unknown. The natural course of the disease is rapid progression from onset to disciform scarring and accompanying loss of visual acuity. Laser photocoagulation is only suitable for 10% of patients with neovascular ARMD. Initial studies using low dose fractionated external beam radiotherapy have demonstrated stable visual acuity over the range of 40–93% at short term follow-up. Only transient acute side effects have been observed. No radiation-induced retinopathy or vasculopathy have been observed. Common radiotherapy macula techniques are reviewed, field sizes examined and criteria for a simple macula technique proposed. A subset of patients with rapidly progressing neovascular ARMD may be candidates for rapid treatment starts. Although follow up times have been short, radiotherapy is a promising option for those patients facing imminent blindness due to rapidly progressive neovascular ARMD.

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Percentage of Foveal versus Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-related Macular Degeneration

10.1101/544254 ◽

2019 ◽

Author(s):

Saghar Bagheri ◽

Ines Lains ◽

Rebecca Silverman ◽

Ivana Kim ◽

Dean Eliott ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Fundus Autofluorescence ◽

Cross Sectional Study ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Cross Sectional ◽

Age Related ◽

The Impact ◽

Foveal Sparing

AbstractObjectivesTo investigate the relationship between visual acuity (VA), total area of geographic atrophy (GA) and percentage of foveal GA.MethodsMulticenter, retrospective cross-sectional study of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF) and optical coherence tomography (OCT) images were collected. Using FAF images aided by OCT, foveal sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area - area within a 1.5 mm diameter circle centered on the fovea centralis - were assessed. Univariable and multiple linear regression analyses were performed.Results54 eyes (mean age 78.7 ±7.7 (SD), 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logMAR, mean total GA 8.8 ± 6.7 mm2 and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = 0.004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = 0.440).ConclusionPercentage of foveal GA was significantly associated with VA impairment, while the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

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Limited Treatment Response during Follow-up after Switching to Aflibercept in Neovascular Age-related Macular Degeneration

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.9.1218 ◽

2021 ◽

Vol 62 (9) ◽

pp. 1218-1226

Author(s):

Gon Soo Choe ◽

Jong Woo Kim ◽

Chul Gu Kim ◽

Jae Hui Kim

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Macular Degeneration ◽

Treatment Response ◽

Visual Outcome ◽

Age Related Macular Degeneration ◽

Neovascular Amd ◽

Age Related ◽

The Mean

Purpose: To investigate the limited response to aflibercept after switching to aflibercept in neovascular age-related macular degeneration (AMD). Methods: This retrospective study included 70 eyes with neovascular AMD that were initially treated with ranibizumab and then switched to aflibercept. The incidence and timing of the limited response to aflibercept were identified and visual outcome was compared between eyes with and without limited response. In addition, factors predictive of limited response were analyzed. Results: A limited response to aflibercept was noted in approximately 1/5 of the patients who underwent switching to aflibercept in neovascular AMD. Switching to aflibercept was performed at a mean of 16.2 ± 12.7 months after diagnosis. During the mean 34.7 months of follow-up after switching, limited response was noted in 15 eyes (21.4%) at a mean of 22.0 ± 13.9 months after switching. The degree of reduction in visual acuity was mean logMAR 0.34 ± 0.41 in eyes with limited response and mean 0.06 ± 0.20 in eyes without (p = 0.002). In addition, the duration between the diagnosis and the switching was shorter (p = 0.012), and the number of ranibizumab injections before switching was lower (p = 0.016) in eyes with limited response than in eyes without. Conclusions: Patients who showed limited response to aflibercept after switching to aflibercept showed a worse visual outcome. The probability of having a limited response is higher when the switching is performed earlier.

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Foveal-Sparing Scotomas in Advanced Dry Age-Related Macular Degeneration

Journal of Visual Impairment & Blindness ◽

10.1177/0145482x0810201004 ◽

2008 ◽

Vol 102 (10) ◽

pp. 600-610 ◽

Cited By ~ 43

Author(s):

Janet S. Sunness ◽

Gary S. Rubin ◽

Abraham Zuckerbrod ◽

Carol A. Applegate

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Good Visual Acuity ◽

Age Related ◽

Foveal Sparing

Foveal-sparing scotomas are common in advanced dry macular degeneration (geographic atrophy). Foveal preservation may be present for a number of years. Despite good visual acuity, these patients have reduced reading rates. Magnification may not be effective if the text becomes too large to “fit” within the central spared area.

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Low Luminance Visual Dysfunction as a Predictor of Subsequent Visual Acuity Loss from Geographic Atrophy in Age-Related Macular Degeneration

Ophthalmology ◽

10.1016/j.ophtha.2008.03.009 ◽

2008 ◽

Vol 115 (9) ◽

pp. 1480-1488.e2 ◽

Cited By ~ 73

Author(s):

Janet S. Sunness ◽

Gary S. Rubin ◽

Aimee Broman ◽

Carol A. Applegate ◽

Neil M. Bressler ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Visual Dysfunction ◽

Age Related ◽

Low Luminance ◽

Visual Acuity Loss

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IMPROVEMENT OF VISUAL ACUITY OVER TIME IN PATIENTS WITH BILATERAL GEOGRAPHIC ATROPHY FROM AGE-RELATED MACULAR DEGENERATION

Retina ◽

10.1097/00006982-200002000-00009 ◽

2000 ◽

Vol 20 (2) ◽

pp. 162-169 ◽

Cited By ~ 34

Author(s):

JANET S. SUNNESS ◽

CAROL A. APPLEGATE ◽

JOEL GONZALEZ-BARON

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Age Related ◽

Over Time

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High frequency SD-OCT follow-up leading to up to biweekly intravitreal ranibizumab treatment in neovascular age-related macular degeneration

Scientific Reports ◽

10.1038/s41598-021-86348-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Cengiz Tuerksever ◽

Christian Pruente ◽

Katja Hatz

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

High Frequency ◽

Subretinal Fluid ◽

Age Related Macular Degeneration ◽

Intravitreal Ranibizumab ◽

Age Related ◽

Ranibizumab Treatment ◽

Sd Oct

AbstractA remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Usually, retreatments are based on nAMD activity as evaluated by Spectral-domain Optical coherence Tomography (SD-OCT), biomicroscopic fundus examination and visual acuity changes. In this prospective pilot study, we aimed to study SD-OCT changes in a high-frequent follow-up manner (weekly (month 0–6), biweekly (month 7–12)) throughout the first year, which consequently led to intravitreal ranibizumab being administered up to biweekly. Best corrected visual acuity (BCVA) was already significantly improved at week 2. Central retinal thickness (CRT), intraretinal and subretinal fluid (SRF) were significantly improved from week 1 onwards. Half of the patients showed nAMD activity at week 2 or 3 and received the first retreatment earlier than 4 weeks after baseline injection. In total, 46% of retreatments were already applied 2 or 3 weeks after the previous treatment. Greater range of CRT and SRF fluctuation during follow-up was associated with lower final BCVA. Lower baseline BCVA and better SRF improvement at week 2 was associated with greater BCVA improvement. In conclusion, high-frequency SD-OCT follow-up provided a good option for adapting treatment in nAMD individually.

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Fixed Regimen Treatment in Unselected Naïve Patients Cohort with Neovascular Age-Related Macular Degeneration

Journal of Ophthalmology ◽

10.1155/2020/8848336 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Ricardo P. Casaroli-Marano ◽

Carolina Bernal-Morales ◽

Lillian Chamorro-López ◽

Marina Dotti-Boada ◽

Juan P. Figueroa-Vercellino ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

The Elderly ◽

Current Treatment ◽

Age Related Macular Degeneration ◽

The Public ◽

Age Related ◽

Intravitreal Aflibercept ◽

One Year

The current treatment of neovascular age-related macular degeneration (nAMD) generates an excessive care pressure in the public health system. The search for a satisfactory treatment regimen, whose anatomical and functional stability may be achieved, is a challenge and a goal to be reached. We analyzed the outcomes in a patient cohort under fixed regimen treatment with intravitreal aflibercept (IVA). A retrospective study, with at least 1-year follow-up, in consecutive treated unselected naïve patients was carried out. Standard protocol was performed and evaluated at baseline, month 4 (after loading dose, LD), and month 12 (after fixed bimonthly regimen). One hundred six patients (123 eyes) aged 80.3 ± 7.7 years were included, receiving 6.8 ± 0.7 IVA. Visual acuity gain after LD was 5.5 ± 12.0 letters ( p < 0.0001 ). At month 12, 23 eyes (18.7%) gained ≥15 letters and 58 (47.1%) had best-corrected visual acuity ≥20/40 (70 letters). The improvement in visual acuity was lower in patients with polypoidal choroidal vasculopathy (+4.9 ± 18.1 letters; p = 0.2544) and somewhat higher in patients with retinal angiomatous proliferation (+5.4 ± 12.3 letters; p = 0.0373 ). Dry macula was present in only 9.8% of cohort at baseline vs. 69.7% at month 12 ( p < 0.0001 ). Atrophy was the most observed complication and related to the elderly patients. The average of follow-up visits was 3 ± 0.5. Functional and anatomical improvement were observed with IVA in a fixed bimonthly regimen treatment after LD, with results maintained up to one year with a good compliance. The fixed bimonthly regimen optimized patient management and logistic issues.

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