Perimeter-adjusted geographic atrophy (GA) progression rate could be linked to the presence of GA in the fellow eye and systemic medication use in non-neovascular age-related macular degeneration (AMD), according to a report published in the British Journal of Ophthalmology.

The researchers analyzed data from the Age-Related Eye Disease Study (AREDS) cohort, which included 4757 patients (55 to 80 years old) recruited from 11 retinal specialty clinics in the 1990s. 

They manually identified GA on 1654 color fundus photos (CFP) of 365 eyes manually with non-neovascular AMD and excluded images with poor quality. They compared GA area growth rate and the change over time of mean GA perimeter to identify GA perimeter-adjusted growth rate. Intraclass correlation coefficient was at least 0.950 for GA perimeter-adjusted growth rate, perimeter, and area. The researchers calculated GA circularity index based on total area and perimeter of GA lesions and compiled medical history and medication use history.


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The study cohort included 318 eyes from 213 patients (52.1% female). The patients’ mean age at AREDS enrollment was 70.6±5.4 years old. Gradable images were captured when participants were a mean of 74.1±5.5 years old.

GA perimeter-adjusted growth rate was linked with history of hypertension (0.109±0.064 vs 0.091±0.059mm/year; percent increase=19.8%; P =.03) and history of cholesterol-lowering medication use (0.142±0.093 vs 0.094±0.057mm/year; percent increase=51.1%, P <.001). They discovered it was linked with beta-blocker use (0.133±0.106 vs 0.096±0.058mm/year; percent increase=38.5%; P =.02), diuretic use (0.124±0.068 vs 0.090±0.057mm/year; percent increase=37.8%, P <.001), and thyroid hormone use (0.121±0.089 vs 0.095±0.057mm/year; percent increase=27.4%, P =.03). The growth rate was linked with presence of GA in the fellow eye (P =.002).

In their multivariable analysis, the researchers found that GA in the fellow eye was linked with 0.028 mm/year higher growth rate (95% confidence interval (CI)=0.008 to 0.048, P =.002) and cholesterol-lowering medication use was associated with 0.045 mm/year higher growth rate (95% CI=0.018 to 0.073, P =.002). Diuretic use was linked with 0.033 mm/year (95% CI=0.015 to 0.050, P <.001).

With baseline systolic and diastolic blood pressures, growth rate retained its link with use of cholesterol-lowering medication use (P =.001), diuretic use (P <.001), and GA in the fellow eye (P =.01).

Limitations of the study included the small number of patients with certain systemic diseases or medication use history. Since AREDS does not include fundus autofluorescence and optical coherence tomography, certain biomarkers were not included in the analysis.

“To our knowledge, the study is the first to suggest a significant association of GA progression rate with systemic medication use in patients with non-neovascular AMD,” researchers report. “We found that GA perimeter-adjusted growth rate was significantly associated with diuretic use and cholesterol-lowering medication use.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Shen LL, Xie Y, Sun M, et al. Associations of systemic health and medication use with enlargement rate of geographic atrophy in age-related macular degeneration. Br J Ophthalmol. Published September 6, 2021. doi: 10.1136/bjophthalmol-2021-319426