Purpose: To assess visual outcomes and rate of neovascular age-related macular degeneration (nAMD) development in eyes with geographic atrophy (GA).
Methods: Retrospective analysis of 18,712 eyes with GA using the CorEvitas Vestrum Health Retina Database.
Results: Mean age at index was 78.6 years (SD = 7.9) and mean visual acuity was 67.5 letters (SD = 13.0, Snellen equivalent 20/45). In total, 18.9% of eyes developed nAMD within 36 months. Eyes with fellow-eye nAMD developed nAMD at over twice the rate of eyes with fellow-eye GA (relative risk 2.34, 95% confidence interval [2.20-2.49]). Mean visual acuity of eyes that did not develop nAMD declined by 12.4 letters (95% confidence interval [12.0-12.9]) within 36 months. Older age and moderate baseline visual impairment (visual acuity <20/40-20/100) independently correlated with accelerated rate of decline. Eyes of patients in the oldest quartile with moderate visual impairment experienced the worst outcomes, losing an average of 19.7 letters over 36 months (95% confidence interval [18.1-21.3]). By 36 months, 70% of eyes had vision below threshold for driving (visual acuity ≤20/40), 42% had low vision (visual acuity ≤20/70), and 23% were legally blind (visual acuity ≤20/200).
Conclusion: Geographic atrophy is associated with significant disease burden. Eyes with GA lose an average of two to three lines of visual acuity within 36 months of follow-up. Older age and moderate baseline visual impairment independently correlate with poorer visual outcomes. Presence of nAMD in the fellow eye is associated with 2-fold higher risk of exudative conversion within 36 months.
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