Progression of Geographic Atrophy: Retrospective Analysis of Patients from the IRIS® Registry (Intelligent Research in Sight)

Ehsan Rahimy; M Ali Khan; Allen C Ho; Meghan Hatfield; Thai Hien Nguyen; Daniel Jones; Alex McKeown; Durga Borkar; Theodore Leng; Ramiro Ribeiro; Nancy Holekamp

doi:10.1016/j.xops.2023.100318

Progression of Geographic Atrophy: Retrospective Analysis of Patients from the IRIS® Registry (Intelligent Research in Sight)

Ophthalmol Sci. 2023 Apr 19;3(4):100318. doi: 10.1016/j.xops.2023.100318. eCollection 2023 Dec.

Authors

Ehsan Rahimy^{1

2}, M Ali Khan³, Allen C Ho³, Meghan Hatfield⁴, Thai Hien Nguyen⁴, Daniel Jones⁵, Alex McKeown⁵, Durga Borkar⁶, Theodore Leng², Ramiro Ribeiro⁵, Nancy Holekamp⁷

Affiliations

¹ Palo Alto Medical Foundation, Palo Alto, California.
² Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California.
³ Wills Eye Hospital, Philadelphia, Pennsylvania.
⁴ Verana Health, Inc, San Francisco, California.
⁵ Apellis Pharmaceuticals, Inc, Waltham, Massachusetts.
⁶ Duke University School of Medicine, Durham, North Carolina.
⁷ Pepose Vision Institute, Chesterfield, Missouri.

Abstract

Purpose: To evaluate disease progression and associated vision changes in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) in 1 eye and GA or neovascular AMD (nAMD) in the fellow eye using a large dataset from routine clinical practice.

Design: Retrospective analysis of clinical data over 24 months.

Subjects: A total of 256 635 patients with GA from the American Academy of Ophthalmology (Academy) IRIS® Registry (Intelligent Research in Sight) Registry (January 2016 to December 2017).

Methods: Patients with ≥ 24 months of follow-up were grouped by fellow-eye status: Cohort 1, GA:GA; Cohort 2, GA:nAMD, each with (subfoveal) and without subfoveal (nonsubfoveal) involvement. Eyes with history of retinal disease other than AMD were excluded. Sensitivity analysis included patients who were managed by retina specialists and had a record of imaging within 30 days of diagnosis.

Main outcome measures: Change in visual acuity (VA), occurrence of new-onset nAMD, and GA progression from nonsubfoveal to subfoveal.

Results: In total, 69 441 patients were included: 44 120 (64%) GA:GA and 25 321 (36%) GA:nAMD. Otherwise eligible patients (57 788) were excluded due to follow-up < 24 months. In both GA:GA and GA:nAMD cohorts, nonsubfoveal study eyes had better mean (standard deviation) VA at index (67 [19.3] and 66 [20.3] letters) than subfoveal eyes (59 [23.9] and 47 [26.9] letters), and 24-month mean VA changes were similar for nonsubfoveal (-7.6 and -6.2) and subfoveal (-7.9 and -6.5) subgroups. Progression to subfoveal GA occurred in 16.7% of nonsubfoveal study eyes in the GA:GA cohort and 12.5% in the GA:nAMD cohort. More new-onset study-eye nAMD was observed in the GA:nAMD (21.6%) versus GA:GA (8.2%) cohorts. Sensitivity analysis supported the robustness of the observations in the study.

Conclusions: This retrospective analysis describes the natural progression of GA lesions and the decline in VA associated with the disease.

Financial disclosures: Proprietary or commercial disclosure may be found after the references.

Keywords: Geographic atrophy; Macular degeneration; Retrospective analysis.