Impact of lesion location and functional parameters on vision-related quality of life in geographic atrophy secondary to AMD

Background/AimsThe primary objective was to determine how structural and functional parameters influence the vision-related quality of life (VRQoL) in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). MethodsThis prospective, non-interventional, natural-history Directional Spread in Geographic-Atrophy study was conducted at the University Eye Hospital in Bonn, enrolling 82 patients with bilateral GA. Parameters such as GA location (assessed by the Early Treatment Diabetic Retinopathy Study grid), best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), reading acuity, and speed were examined. The association between these parameters and VRQoL, as gauged using the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25), was analyzed through least absolute shrinkage and selection operator with linear mixed-effects models. ResultsThe average total GA area observed was 2.9 {+/-} 1.2 mm2 (better eye) and 3.1 {+/-} 1.3 mm2 (worse eye). The VRQoL scores for distance and near activities were most associated with the inner lower and inner left subfields of the better eye. For foveal-sparing patients, the LLVA of the better eye was the predominant determinate impacting all VRQoL scales. ConclusionGA location, specifically the inner lower and inner left subfields of the better eye, has a notable effect on VRQoL in GA patients. LLVA stands out as especially vital in foveal-sparing patients, underscoring the importance for clinicians to incorporate considerations of GA location and functional parameters into their risk-benefit assessments for emerging treatments. Key messengesO_ST_ABSWhat is already known on this topicC_ST_ABSDespite recent therapeutic advancements, the relationship between GA markers and VRQoL remains unclear. What this study addsThis research reveals the distinct value of specific structural and functional GA markers, notably the inner left and inner lower subfields, and LLVA, in relation to VRQoL in GA patients. How this study might affect research, practice, or policyUnderstanding these structural and functional markers will guide clinicians in personalized treatment decisions and encourage further research into more tailored therapeutic interventions.