Progression of geographic atrophy with subsequent exudative neovascular disease in age-related macular degeneration: AREDS2 Report 24.

Amitha Domalpally // Publications // Oct 20 2020

PubMed ID: 33075546

Author(s): Hwang CK, Agrón E, Domalpally A, Cukras CA, Wong WT, Chew EY, Keenan TD; AREDS2 Research Group. Progression of geographic atrophy with subsequent exudative neovascular disease in age-related macular degeneration: AREDS2 Report 24. Ophthalmol Retina. 2020 Oct 16. pii: S2468-6530(20)30413-9. doi: 10.1016/j.oret.2020.10.008. [Epub ahead of print] PMID 33075546

Journal: Ophthalmology. Retina, Oct 2020

PURPOSE To examine whether the rate of geographic atrophy (GA) enlargement is influenced by subsequent exudative neovascular age-related macular degeneration (NV-AMD), hence, to explore indirectly whether non-exudative NV-AMD may slow GA enlargement.

DESIGN Post hoc analysis of a controlled clinical trial cohort.

PARTICIPANTS Age-Related Eye Disease Study 2 (AREDS2) participants, aged 50-85 years.

METHODS Baseline and annual stereoscopic color fundus photographs were evaluated for (i) GA presence and area, and (ii) exudative NV-AMD presence. Two cohorts were constructed: eyes with GA at study baseline (prevalent cohort) and eyes that developed GA during follow-up (incident cohort). Mixed-model regression of the square root of GA area was performed according to the presence/absence of subsequent exudative NV-AMD.

OUTCOME MEASURES Change over time in square root of GA area.

RESULTS Of the 757 eyes in the incident GA cohort, over a mean follow-up period of 2.3 years (SD 1.2), 73 (9.6%) eyes developed subsequent exudative NV-AMD. GA enlargement in these eyes was significantly slower (0.20 mm/year, 95% CI 0.12-0.28) compared with the other 684 eyes that did not develop subsequent exudative NV-AMD (0.29 mm/year, 95% CI 0.27-0.30; p=0.037). Of the 456 eyes in the prevalent GA cohort, over a mean follow-up period of 4.1 years (SD 1.4), 63 (13.8%) eyes developed subsequent exudative NV-AMD. GA enlargement in these eyes was similar (0.31 mm/year, 95% CI 0.24-0.37) compared with the other 393 eyes that did not develop subsequent exudative NV-AMD (0.28 mm/year, 95% CI 0.26-0.29; p=0.37).

CONCLUSIONS In eyes with recent GA, GA enlargement prior to the development of exudative NV-AMD appears slowed. This association was not observed in eyes with more long-standing GA, which have larger lesion sizes. Hence, perilesional non-exudative choroidal neovascular tissue (presumably present before the development of clinically apparent exudation) may slow enlargement of smaller GA lesions through improved perfusion. This hypothesis warrants further evaluation in prospective studies.

Copyright © 2020. Published by Elsevier Inc.