Study Finds 2 Factors Accelerate Geographic Atrophy Progression

A banded pattern found on fundus autofluorescence and presence of reticular pseudodrusen (RPD) speed up geographic atrophy (GA) progression and can be predictive factors for the condition progressing, according to a study published in Photodiagnosis and Photodynamic Therapy.

GA, an advanced form of dry age-related macular degeneration (AMD), is a mystery when it comes to an underlying mechanism of progression. Study investigators set out to determine the role of fundus autofluorescence (FAF) patterns surrounding GA, baseline GA size, the presence of RPD, the condition of the fellow eye, and the presence of systemic vascular diseases (such as diabetes, atherosclerosis, systemic hypertension) on the progression of GA.

The retrospective study included 75 eyes of 52 patients with GA. Investigators took FAF using scanning laser ophthalmoscopy and measured areas of GA with the Region Finder software program using Heidelberg Retinal Angiograph 2. They classified FAF patterns around GA and recorded the presence of RPD and systemic diseases. Median follow-up was 2.6 years (interquartile range, 1–9.2).

Investigators found that the median progression rate of the banded pattern (median 0.97 mm²/year) was significantly higher than other fundus autofluorescence patterns (median 0.85 mm²/year) (P =.03). The presence of RPD also mattered: eyes with the deposits had a significantly higher progression rate (median 1.21 mm²/year) than those without them (median 0.79 mm²/year,  P =.007). None of the systemic diseases were related to lesion progression rates.

“Geographic atrophy is a common cause of vision loss and legal blindness,” the study explains.“A detailed ophthalmological examination supported by imaging methods may provide information about the prognosis of the disease. Fundus autofluorescence is an essential imaging method to predict the risk of progression. The current study defined the risk factors for progression of GA including individual risk factors and FAF images. Determining the risky cases is important in order to formulate a plan for managing the disease with novel, promising therapies.”

The study’s limitations included its retrospective design and small sample size. Info on mechanisms and risk factor interaction is absent, so further study is needed. Despite these, researchers report that their small retrospective has merit and clinical application. “We believe it presents some valuable information: certain FAF patterns such as diffuse and band patterns, the presence of RPD, a large baseline atrophic area, and having GA on the fellow eye, are all signs indication [sic] a negative prognosis. Systemic vascular diseases such as diabetes and hypertension have no impact on prognosis of GA.”

Reference

Sahinoglu-Keskek N, Sermet F. Impact of ocular and systemic risk factors on progression of geographic atrophy in age-related macular degeneration. Photodiagnosis Photodyn Ther. 2021;33(1);102171. doi:10.1016/j.pdpdt.2020.102171.