Ophthalmology science · 2025
Longitudinal Study of Macular Preservation and Geographic Atrophy Progression in Age-Related Eye Disease Study 2.
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Zhang Sairi, Saunders Thomas F, Csaky Karl G, Agrón Elvira, Keenan Tiarnán D L, Chew Emily Y, Blodi Barbara A, Domalpally Amitha
Аннотация
PURPOSE: To investigate the natural history of macular tissue preservation in geographic atrophy (GA) by evaluating the relationship between the macular tissue integrity index (MTII) and best-corrected visual acuity (BCVA) over time.
DESIGN: Post hoc analysis of Age-Related Eye Disease Study 2 (AREDS2), a multi-center, randomized clinical trial.
PARTICIPANTS: Participants from the AREDS2 fundus autofluorescence ancillary study with nonsubfoveal GA.
METHODS: Areas of GA were segmented by a deep learning algorithm and verified by expert graders. Macular tissue integrity index was defined as the percentage of the macula without GA within the central 1-mm and 3-mm circles. Baseline associations with BCVA were assessed, and longitudinal analyses evaluated GA progression, MTII loss, and BCVA decline over time.
MAIN OUTCOME MEASURES: Geographic atrophy area, MTII, and BCVA.
RESULTS: Two hundred forty-three eyes (194 participants) were included. The median follow-up was 2 years. At baseline, the mean GA area was 1.8 mm2 (standard deviation 2.7), and the growth rate was 1.3 mm2/year. Baseline mean MTII in the 1-mm zone was 95.2% (standard deviation 9.1) with a decrease of 5.4%/year, and 87.3% (standard deviation 14.5) in the 3-mm zone with a decrease of 6.7%/year. Baseline mean BCVA was 76.4 letters (standard deviation 11.8; Snellen equivalent 20/30) with a 1.5-letter loss/year. Baseline MTII showed significant correlations with BCVA (1 mm: r = 0.17, P = 0.01; 3 mm: r = 0.14, P = 0.03), while GA area was not significantly associated with BCVA (r = -0.02, P = 0.71). Multivariable analysis showed that MTII in the 1-mm and 3-mm zones was associated with visual loss (both P < 0.0001). When eyes were stratified by MTII decline rate (stable/moderate/rapid), those in the rapid group showed numerically greater vision loss and GA growth.
CONCLUSIONS: This study characterizes the natural history of central macular preservation in GA using MTII. Results show moderate but significant associations with BCVA cross-sectionally and longitudinally. These findings suggest that MTII may offer complementary functional context for evaluating disease progression in GA, warranting further validation in clinical trial settings.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Post hoc analysis of Age-Related Eye Disease Study 2 (AREDS2), a multi-center, randomized clinical trial.
PARTICIPANTS: Participants from the AREDS2 fundus autofluorescence ancillary study with nonsubfoveal GA.
METHODS: Areas of GA were segmented by a deep learning algorithm and verified by expert graders. Macular tissue integrity index was defined as the percentage of the macula without GA within the central 1-mm and 3-mm circles. Baseline associations with BCVA were assessed, and longitudinal analyses evaluated GA progression, MTII loss, and BCVA decline over time.
MAIN OUTCOME MEASURES: Geographic atrophy area, MTII, and BCVA.
RESULTS: Two hundred forty-three eyes (194 participants) were included. The median follow-up was 2 years. At baseline, the mean GA area was 1.8 mm2 (standard deviation 2.7), and the growth rate was 1.3 mm2/year. Baseline mean MTII in the 1-mm zone was 95.2% (standard deviation 9.1) with a decrease of 5.4%/year, and 87.3% (standard deviation 14.5) in the 3-mm zone with a decrease of 6.7%/year. Baseline mean BCVA was 76.4 letters (standard deviation 11.8; Snellen equivalent 20/30) with a 1.5-letter loss/year. Baseline MTII showed significant correlations with BCVA (1 mm: r = 0.17, P = 0.01; 3 mm: r = 0.14, P = 0.03), while GA area was not significantly associated with BCVA (r = -0.02, P = 0.71). Multivariable analysis showed that MTII in the 1-mm and 3-mm zones was associated with visual loss (both P < 0.0001). When eyes were stratified by MTII decline rate (stable/moderate/rapid), those in the rapid group showed numerically greater vision loss and GA growth.
CONCLUSIONS: This study characterizes the natural history of central macular preservation in GA using MTII. Results show moderate but significant associations with BCVA cross-sectionally and longitudinally. These findings suggest that MTII may offer complementary functional context for evaluating disease progression in GA, warranting further validation in clinical trial settings.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.