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  • Macular Atrophy in Wet AMD

    By Jean Shaw
    Selected By: Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, October 2018

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    Domalpally et al. investigated the prevalence of macular retinal pigment epithelial atrophy in eyes with recently diagnosed neovascular age-related macular degeneration (AMD). In addition, they assessed imaging char­acteristics in 3 groups of patients: 1) those with macular atrophy before the onset of choroidal neovascularization (CNV), 2) those with macular atrophy concomitant to CNV diagnosis, and 3) those who developed macular atrophy during follow-up of CNV. They found that macular atrophy is common in neovascular AMD and often can be attributed to preexisting geographic atrophy (GA). In addition, they found that the presence of macular atrophy is an indicator of poor visual prognosis.

    For this cohort study, the researchers evaluated participants of the AREDS2 FAF (Age-Related Eye Disease Study 2 fundus autofluorescence) ancillary study. AREDS2 FAF included 2,509 participants (4,328 eyes) at risk of de­veloping advanced AMD. Color photo­graphs and FAF images were evaluated in those who developed CNV. The main outcome measures were the incidence and enlargement rate of macular atro­phy and visual acuity (VA) changes in eyes with incident CNV.


    COMPARISON. Color and autofluorescence images showing GA (top) in an eye that developed wet AMD at the next annual visit (bottom).

    Over 4 years, incident CNV developed in 334 of the 4,328 eyes. Of these, 137 eyes (41%) had macular atrophy at the event visit (defined as the point at which CNV was identified by the image reading center)—and of those 137 eyes, half had preexisting GA. Of the 197 eyes (59%) that did not have macular atrophy at the event visit, 49 developed it during follow-up.

    The mean area of mac­ular atrophy was largest in eyes with preexisting GA and CNV, and macular atrophy involved the center of the macula in over two-thirds of all eyes. With regard to VA, by 3 years of fol­low-up, eyes with macular atrophy had lost a mean of 10.9 letters, while those without it had lost a mean of 3.7 letters.

    The original article can be found here.