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Central geographic atrophy vs. neovascular age–related macular degeneration: differences in longitudinal vision-related quality of life

Graefe's Archive for Clinical and Experimental Ophthalmology volume 259, pages 307–316 (2021)Cite this article

Abstract

Objective

Prior studies of vision-related quality of life (VRQoL) have examined advanced age-related macular degeneration (AMD) as a single group or focused on neovascular AMD (nAMD), even though advanced AMD can refer to either central geographic atrophy (GA) or nAMD. We compared the natural progression of VRQoL in central GA versus nAMD.

Methods

We included Age-Related Eye Disease Study (AREDS) participants with central GA (n = 206) or nAMD (n = 198) who completed the National Eye Institute Visual Function Questionnaire (NEI-VFQ) between 1997 and 2005. The rate of change of VRQoL was calculated as the slopes of linear models fit to longitudinal individual-level NEI-VFQ scores. Multivariable regressions identified factors associated with experiencing a decline in VRQoL during the study period and cross-sectional VRQoL score.

Results

There was a minor decline in VRQoL prior to the development of nAMD but a significantly steeper decline after progression to nAMD (0.49 ± 2.91 vs. 3.30 ± 5.58 NEI-VFQ units/year; p < 0.001). The rates of VRQoL decline were similar before and after the development of central GA (1.99 ± 4.97 vs. 1.68 ± 4.65 NEI-VFQ units/year; p = 0.66). Prior to the development of advanced AMD, the rate of VRQoL decline was greater for participants destined to develop central GA versus nAMD (p = 0.007), while postprogression to advanced disease, the rate was greater in nAMD compared with central GA (p = 0.012). Female gender (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.38-5.06; p = 0.003) and higher baseline VRQoL score (OR 1.03, 95% CI 1.01–1.06; p = 0.006) were independently associated with experiencing a longitudinal decline in VRQoL.

Conclusion

The natural progression of VRQoL differed in central GA versus nAMD, both before and after the development of advanced disease, suggesting that future studies should consider separating these phenotypes. Females and those with a higher baseline VRQoL were more likely to experience a longitudinal decline in VRQoL following progression to advanced AMD.

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Fig. 1

Availability of data and material

The Age-Related Eye Disease Study (AREDS) data are available upon request for authorized access: https://dbgap.ncbi.nlm.nih.gov/aa/wga.cgi?page=login.

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Acknowledgments

The dataset used for the analyses described in this manuscript was obtained from the AREDS Database through dbGaP accession number phs000001.v3.p1. Funding support for AREDS was provided by the National Eye Institute (N01-EY-0-2127). We would like to thank the AREDS participants and the AREDS Research Group for their valuable contribution to this research.

Funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number T35AG049685 (Recipient: Ahluwalia) and P30 EY026878 from the National Eye Institute (NEI) (Recipient: Yale Vision Science Core).

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  1. Department of Ophthalmology and Visual Science, Yale University School of Medicine, 40 Temple Street, Suite 1B, New Haven, CT, 06510, USA

    Aneesha Ahluwalia, Liangbo L. Shen & Lucian V. Del Priore

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  1. Aneesha Ahluwalia
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  2. Liangbo L. Shen
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  3. Lucian V. Del Priore
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Contributions

Conceptualization: Aneesha Ahluwalia, Liangbo L. Shen, and Lucian V. Del Priore; Methodology: Aneesha Ahluwalia, and Liangbo L. Shen; Formal analysis and investigation: Aneesha Ahluwalia; Writing—original draft preparation: Aneesha Ahluwalia; Writing—review and editing: Aneesha Ahluwalia, Liangbo L. Shen, and Lucian V. Del Priore; Supervision: Lucian V. Del Priore.

Corresponding author

Correspondence to Lucian V. Del Priore.

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Conflicts of interest

No conflicting relationship exists for any author. Lucian V. Del Priore serves as a consultant for Astellas Institute for Regenerative Medicine.

Ethics approval

This study was exempted by the Yale Institutional Review Board.

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Code availability

All study analyses were performed using R 3.6.0 (R Foundation for Statistical Computing, Vienna, Austria).

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Ahluwalia, A., Shen, L.L. & Del Priore, L.V. Central geographic atrophy vs. neovascular age–related macular degeneration: differences in longitudinal vision-related quality of life. Graefes Arch Clin Exp Ophthalmol 259, 307–316 (2021). https://doi.org/10.1007/s00417-020-04892-5

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  • DOI: https://doi.org/10.1007/s00417-020-04892-5

Keywords

  • Vision-related quality of life
  • NEI-VFQ
  • Age-related macular degeneration
  • Geographic atrophy
  • Neovascular age-related macular degeneration