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  • Does exudative neovascular AMD affect rate of geographic atrophy enlargement?

    Retina/Vitreous

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    Review of: Progression of Geographic Atrophy with Subsequent Exudative Neovascular Disease in Age-Related Macular Degeneration

    Hwang C, Agrón E, Domalpally A, et al. Ophthalmology Retina, February 2021

    This study assessed whether the rate of geographic atrophy (GA) enlargement is influenced by subsequent exudative neovascular AMD.

    Study design

    Researchers performed a post hoc analysis of AREDS2. They evaluated 2 cohorts: eyes with GA at baseline and eyes that GA developed during follow-up. Stereoscopic fundus photos at baseline and annual visits were analyzed for presence and area of GA, and presence of exudative neovascular AMD. The main outcome was change over time in square root of GA area.

    Outcomes

    Of the 757 eyes that developed GA during the mean follow-up of 2.3 years, 73 (9.6%) developed subsequent exudative neovascular AMD. GA enlargement in these eyes was slower than in eyes that did not develop exudative neovascular AMD (0.20 mm/year vs 0.29 mm/year). Of 456 eyes with GA at baseline, 63 (13.8%) developed subsequent exudative neovascular AMD over a mean follow-up of 4.1 years. Lesion enlargement in these eyes was relatively similar to eyes without subsequent exudative neovascular AMD.

    Limitations

    The study used fundus photos to measure the GA areas and detect exudative neovascular AMD instead of other imaging modalities.

    Clinical significance

    In eyes that developed GA during the AREDS2 study, GA enlargement before the development of exudative neovascular AMD was slower than in eyes that did not develop AMD. This difference was not present in patients who already had GA at their baseline study visit. There may be a potential protective effect of choroidal neovascularization on the progression of GA in patients with recent onset of GA. At this point, further studies are needed to better understand this relationship before this study’s findings would change current clinical practice and treatment paradigms.