Retrospective study finds geographic atrophy can cause 2 to 3 lines of visual acuity loss within 36 months

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A large study that retrospectively analyzed the visual outcomes and rate of development of neovascular age-related macular degeneration (nAMD) in eyes with geographic atrophy (GA) found that GA can cause a loss of 2 to 3 lines of visual acuity (VA) within 36 months of follow-up, according to first author Aumer Shughoury, MD, from Indiana University School of Medicine, Indianapolis.

Shughoury and colleagues analyzed 18,712 eyes with GA identified in the CorEvitas Vestrum Health Retina Database.

The mean patient age at index was 78.6 years, and the mean VA was 67.5 letters (Snellen equivalent 20/45). Among these eyes, 18.9% of eyes developed nAMD within 36 months.

The investigators also reported the following findings:

• Eyes with fellow-eye nAMD developed nAMD at more than twice the rate of eyes with fellow-eye GA (relative risk, 2.34; 95% confidence interval [CI], 2.20–2.49).
• The mean VA of eyes that did not develop nAMD decreased by 12.4 letters (95% CI, 12.0–12.9) within 36 months.
• Older patient age and moderate baseline visual impairment (VA <20/40–20/100) were independently correlated with an accelerated rate of decline. The eyes of the oldest patients with moderate visual impairment experienced the worst outcomes, in that they lost an average of 19.7 letters over 36 months (95% CI, 18.1–21.3).
• At the 36-month time point, 70% of eyes had vision below threshold for driving (VA≤20/40), 42% had low vision (VA ≤20/70), and 23% were legally blind (VA ≤20/200).

The investigators commented that GA is associated with a significant disease burden and cited the lines of vision lost within a 36-month period, the effect of older patient age and moderate baseline visual impairment that were correlated independently with poorer visual outcomes, and the fellow-eye nAMD that was seen to be associated with a 2-fold higher risk of exudative conversion within the short 36 months.

Reference

1. Shughoury A, Boucher N, Aggarwal N, Ciulla TA. Three-year clinical outcomes in geographic atrophy: an analysis of 18,712 patient eyes. Retina. 2025;45:188-197. doi:10.1097/IAE.0000000000004285