Progression of Loss of Vision From Centre-Involving Macular Atrophy in Eyes Treated for nAMD.

Background: This study aimed to characterise visual acuity (VA) changes in eyes without baseline macular atrophy (MA) that subsequently developed MA during treatment for neovascular age-related macular degeneration (nAMD).

Methods: A case-control analysis was performed using data from a multicentre real-world AMD registry. We compared VA outcomes in 1998 treatment-naïve eyes without MA at baseline and ≥ 5 years of follow-up. Two matched groups (999 eyes each) were analysed: eyes that developed incident MA and those that never did.

Results: Comparisons were made between two matched groups of 999 eyes each with incident MA and those that never developed it with at least 5 years of follow-up. Final VA was best in eyes that never developed MA, followed by eyes that developed extrafoveal and sub-foveal MA (68.9 ± 16.7, 67.0 ± 16.9 and 52.1 ± 23.6 letters, p < 0.01). Eyes with incident MA had more inactive disease visits compared to those that never developed MA. Features associated with poor final VA included the presence of sub-foveal MA (odds ratio [OR] [95% confidence interval (CI)] -16.63 [-18.7 to 14.56], p < 0.01) and a higher proportion of active visits (per 10%) (OR [95% CI] -0.73 [-1.12 to 0.34], p < 0.01). The mean time to lose five letters of vision from first grading of sub-foveal MA was 17.3 ± 4.6 months.

Conclusion: It is important to achieve disease inactivity in nAMD despite its association with incident MA, as neovascular complications play a significant role in VA loss. The long duration between the incidence of MA and clinically significant loss of vision offers an opportunity for potential interventions against atrophy.