GA lesion location plays role in vision-related quality of life
Key takeaways:
- Vision-related quality of life is primarily dependent on the eye with better vision.
- An analysis found the inner lower and inner left subfields of the better-seeing eye were the most relevant.
Geographic atrophy lesion location may be a critical factor in vision-related quality of life, according to a presentation at Angiogenesis, Exudation, and Degeneration 2025.
Vision-related quality of life is primarily dependent on the eye with better vision, Monika Fleckenstein, MD, of John A. Moran Eye Center, said.
“Interestingly, the size of GA shows inconsistent association with vision-related quality of life across different clinical studies,” she said. “So, how important is the location of the GA lesion on vision-related quality of life?”
Fleckenstein and colleagues examined 82 patients with bilateral GA secondary to age-related macular degeneration with the National Eye Institute Visual Function Questionnaire to assess the impact of GA on daily activities. Functional parameters evaluated included best corrected visual acuity, low luminance visual acuity (LLVA), reading acuity and reading speed, while multimodal imaging techniques included OCT, fundus autofluorescence and near infrared imaging.
To determine the topographic locations of GA, an ETDRS grid was placed on fundus autofluorescence images to evaluate GA progression in the subfields, and the size of the atrophy in the subfields was measured.
Through univariate and multivariate regressions, the analysis found that subfields in the eye with better vision were more strongly associated with vision-related changes in quality of life.
“Specifically, the inner lower and the inner left subfields of the better eye were the most relevant,” Fleckenstein said. “The next most important subfields included the outer lower subfield of the better eye and the inner lower subfield of the worse eye, which also demonstrated significance in the multivariate analysis.”
According to Fleckenstein, the inner lower subfield of the ETDRS grid is “crucial” for driving due to its impact on the ability to see street signs and traffic signals. Additionally, the inner left subfield, “which corresponds to the left visual field,” may be a factor in reading initiation and transitioning in reading lines.
When looking at all structural and functional parameters, in the univariate analysis, LLVA in the eye with better vision had the most pronounced impact on vision-related quality of life, followed by the inner lower and inner left subfields of the ETDRS grid.
The size of GA in the better eye was ranked eighth among the examined parameters, according to Fleckenstein.
In the multivariate analysis, LLVA was the most important variable, the inner lower subfield on the ETDRS grid was second and BCVA was third.
“Notably, the variables of the worse eye were much less associated with vision-related quality of life,” she said. “Therefore, the condition of the better eye is clearly more crucial for patients’ overall quality of life.”
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Fleckenstein M, et al. Geographic atrophy: Association of lesion location and functional parameters with vision-related quality of life. Presented at: Angiogenesis, Exudation, and Degeneration 2025; Feb 8, 2025 (virtual meeting).
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