June 5, 2020 Conference


Central Geographic Atrophy vs. Neovascular Age-related Macular Degeneration: Differences in Longitudinal Vision-related Quality of Life

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Ms. Aneesha Ahluwalia, Yale University School of Medicine (Presenter)
Mr. Liangbo (Linus) Shen, Yale School of Medicine, Yale University
Dr. Lucian Del Priore
Objective: Prior studies of vision-related quality of life (VRQoL) have examined advanced AMD as a single group or focused on neovascular AMD (nAMD), despite the fact that 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). 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: In nAMD, there was a minor decline in VRQoL prior to conversion but a significantly steeper decline after conversion (0.49 ± 2.91 vs. 3.30 ± 5.58 NEI-VFQ units/year; p<0.001). For central GA, the rate of VRQoL decline was similar before and after the development of advanced disease (1.99 ± 4.97 vs. 1.68 ± 4.65 NEI-VFQ units/year; p=0.66). Prior to conversion to advanced disease, the rate of VRQoL decline was greater for patients destined to develop central GA versus nAMD (p=0.007), while post-conversion, the rate was greater in nAMD compared with central GA (p=0.012). Female gender (OR 2.61, 95% CI 1.38-5.06; p=0.0029) and higher baseline VRQoL score (OR 1.03, 95% CI 1.01-1.06; p=0.0058) 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 conversion to advanced disease, suggesting that future studies should separate these phenotypes. Females and those with a higher baseline VRQoL were more likely to experience a longitudinal decline in VRQoL after conversion to advanced disease.
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