Visual functioning and geographic atrophy imaging characteristics in age-related macular degeneration

To investigate the relationship between visual functioning as measured by the National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and geographic atrophy (GA) imaging characteristics including foveal involvement, multifocal lesions, and GA size.

This cross-sectional cohort study included patients from the University of Colorado Age-related macular degeneration (AMD) registry, enrolled between July 2014 and May 2023, who had GA in at least one eye and completed the VFQ-25 at time of study enrollment. GA size was averaged between the two eyes for each patient. General linear modeling was used to assess the association between GA imaging characteristics with the outcome of Rasch-transformed VFQ-25 scores.

A total of 140 AMD patients with GA and VFQ-25 scores were included in the study. LogMAR visual acuity for the better-seeing eye of each patient was negatively associated with Rasch-transformed VFQ scores (-3.03, standard error (SE): 0.46, p < 0.0001). Foveal involvement in both eyes was significantly associated with worse Rasch-transformed scores when compared to those without foveal involvement in either eye (-1.33, SE: 0.38, p = 0.0006). Multifocal lesions in both eyes compared with unifocal lesions in both eyes had no significant difference in score (p = 0.179). GA size was significantly associated with worse VFQ-25 scores (-0.09, SE: 0.02), p < 0.0001), which did not remain significant after adjustment for LogMAR of both eyes (p = 0.137).

We found bilateral foveal involvement and averaged GA size were significantly associated with worse Rasch-transformed VFQ-25 scores, but these associations did not remain significant after adjustment for visual acuity. Unilateral GA was significantly associated with better scores. This study highlights the impact GA imaging characteristics and bilateral involvement have on visual functioning.

WHAT IS KNOWN: Geographic atrophy (GA) in age-related macular degeneration negatively impacts visual functioning, and prior studies suggest that both lesion characteristics and visual acuity contribute to patient-reported outcomes.The gold-standard for Telangiectatic capillaries (TelCaps) detection is indocyanine green angiography, which is invasive and may not be readily available in all settings.

Bilateral foveal involvement and larger GA size were significantly associated with worse visual functioning as measured by Rasch-transformed VFQ-25 scores.Infrared reflectance imaging complemented by optical coherence tomography B-scans are effective in the detection and measurement of TelCaps, which appeared to be dynamic lesions that remodel over time. Patients with unilateral GA reported better visual functioning, underscoring the importance of preserving vision in the better-seeing eye.Eyes with DME and TelCaps with at least one year of follow-up ended up with persistent edema and stable or worse vision after injection therapy.