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Geographic Atrophy Size Progression Correlates Better with Longitudinal Changes in Quantitative Contrast Sensitivity
Filippos Vingopoulos1,2, Marta Stevanovic2, Peyman Razavi1
1Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Purpose:
Investigate the cross-sectional and longitudinal correlations between total geographic atrophy (GA) size and quantitative contrast sensitivity function (qCSF).
Design:
Prospective, cross-sectional, and longitudinal observational study between November 2018 and March 2023 at Massachusetts Eye and Ear.
Subjects:
A total of 83 foveal involving GA eyes cross-sectionally and 30 foveal involving GA eyes longitudinally.
Methods:
Contrast sensitivity (CS) was measured with the qCSF device along with same day spectral-domain OCT and fundus autofluorescence (FAF). Geographic atrophy was defined as hypoautofluorescent lesions on FAF corresponding to complete retinal pigment epithelium and outer retinal atrophy on spectral-domain OCT. Total GA size was measured on FAF using the semiautomatic Heidelberg Region Finder tool. Mixed-effects multivariate regression models were performed to evaluate correlations between GA size, qCSF metrics, and visual acuity (VA).
Main Outcome Measures:
Total GA size, longitudinal changes in total GA size, qCSF outcomes (area under the logarithm of contrast sensitivity function [AULCSF], low contrast VA [LCVA], CS thresholds at 1-18 cycles per degree [cpd]), and longitudinal changes in qCSF outcomes.
Results:
Cross-sectionally (n = 83), total GA was associated with multiple qCSF outcomes including AULCSF and CS thresholds at 1, 1.5, 3, 6, and 12 cpd (β = -0.23 to -0.39, all P < 0.05), but was not associated with VA (β = 0.08, P = 0.47). At 17.2 months follow-up (range: 6-37) (n = 30), an average increase of 1 mm2 in total GA size was associated with a nonstatistically significant decrease of 0.01 in VA (P = 0.88), but a statistically significant decrease in CS (-0.05 for AUCLSF, -0.05 for LCVA, -0.04 for 1 cpd, -0.05 for 1.5 cpd, and -0.06 for 3 cpd, all P < 0.05). Standardized regression coefficients suggest that the statistically significant decrease in CS metrics per mm2 of GA size increase are 11-fold to 20-fold bigger compared to the nonstatistically significant decrease in VA (-0.33 to -0.62 for qCSF versus -0.03 for VA).
Conclusions:
Total GA and longitudinal change in GA size were found to be associated with significant changes in qCSF CS, but not with VA or change in VA. Contrast sensitivity seems to be a better functional endpoint to measure treatment effects in GA.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
