Visual Functioning and Progression from Intermediate Age-Related Macular Degeneration (AMD) to Advanced AMD

To investigate whether the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) can predict the progression of intermediate age-related macular degeneration (iAMD) to advanced non-neovascular (NNV) or neovascular (NV).

380 patients aged 55-99 years with iAMD in one or both eyes and no evidence of geographic atrophy (GA) or NV AMD in either eye were enrolled (2014-2023 into the University of Colorado AMD registry) with follow-up through November 2024. AMD classification and progression were based on multimodal imaging review by two vitreoretinal surgeons. Baseline visual acuity (LogMAR) and VFQ-25 scores were collected at enrollment. Cox proportional hazards models assessed time to progression. Kaplan-Meier analysis evaluated significant VFQ-25 subscales.

Among 380 iAMD participants (mean age 76.1 years, 95.8% white), 131 (34.5%) progressed to advanced AMD over a median 32-month follow up (SD- 27). Worse baseline LogMAR in both the better- (HR: 6.39, 95% CI: 1.57-26; p = 0.001) and worse- (HR: 2.64, 95% CI: 1.26-5.55; p = 0.010) seeing eyes predicted progression. Lower baseline VFQ-25 general vision (HR: 0.84 per 10-point increase, 95% CI: 0.74-0.95, p = 0.006) and distance activities scores (HR: 0.89 per 10-point increase, 95% CI: 0.80-0.98, p = 0.019) predicted progression during follow-up. In multivariable analysis adjusting for age and LogMAR for both eyes, this remained significant for general vision (HR: 0.85, 95% CI:0.75-0.98, p = 0.022). Kaplan-Meier analysis showed faster progression for patients with baseline general vision and distance activity subscores below 85 (p = 0.013 and p = 0.011, respectively).

Lower NEI-VFQ-25 general vision subscale scores independently predicted progression to advanced AMD.