Skip to main content

Advertisement

SpringerLink
Log in

Central geographic atrophy vs. neovascular age–related macular degeneration: differences in longitudinal vision-related quality of life

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Objective

Prior studies of vision-related quality of life (VRQoL) have examined advanced age-related macular degeneration (AMD) as a single group or focused on neovascular AMD (nAMD), even though advanced AMD can refer to either central geographic atrophy (GA) or nAMD. We compared the natural progression of VRQoL in central GA versus nAMD.

Methods

We included Age-Related Eye Disease Study (AREDS) participants with central GA (n = 206) or nAMD (n = 198) who completed the National Eye Institute Visual Function Questionnaire (NEI-VFQ) between 1997 and 2005. The rate of change of VRQoL was calculated as the slopes of linear models fit to longitudinal individual-level NEI-VFQ scores. Multivariable regressions identified factors associated with experiencing a decline in VRQoL during the study period and cross-sectional VRQoL score.

Results

There was a minor decline in VRQoL prior to the development of nAMD but a significantly steeper decline after progression to nAMD (0.49 ± 2.91 vs. 3.30 ± 5.58 NEI-VFQ units/year; p < 0.001). The rates of VRQoL decline were similar before and after the development of central GA (1.99 ± 4.97 vs. 1.68 ± 4.65 NEI-VFQ units/year; p = 0.66). Prior to the development of advanced AMD, the rate of VRQoL decline was greater for participants destined to develop central GA versus nAMD (p = 0.007), while postprogression to advanced disease, the rate was greater in nAMD compared with central GA (p = 0.012). Female gender (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.38-5.06; p = 0.003) and higher baseline VRQoL score (OR 1.03, 95% CI 1.01–1.06; p = 0.006) were independently associated with experiencing a longitudinal decline in VRQoL.

Conclusion

The natural progression of VRQoL differed in central GA versus nAMD, both before and after the development of advanced disease, suggesting that future studies should consider separating these phenotypes. Females and those with a higher baseline VRQoL were more likely to experience a longitudinal decline in VRQoL following progression to advanced AMD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and material

The Age-Related Eye Disease Study (AREDS) data are available upon request for authorized access: https://dbgap.ncbi.nlm.nih.gov/aa/wga.cgi?page=login.

References

  1. Yuzawa M, Fujita K, Tanaka E, Wang EC (2013) Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice. Clin Ophthalmol (Auckland, NZ) 7:1325–1332. https://doi.org/10.2147/opth.S45248

    Article  Google Scholar 

  2. Sadda SR, Chakravarthy U, Birch DG, Staurenghi G, Henry EC, Brittain C (2016) Clinical endpoints for the study of geographic atrophy secondary to age-related macular degeneration. Retina 36(10):1806–1822. https://doi.org/10.1097/IAE.0000000000001283

    Article  PubMed  PubMed Central  Google Scholar 

  3. Mangione CM, Lee PP, Pitts J, Gutierrez P, Berry S, Hays RD (1998) Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol (Chicago, Ill : 1960) 116(11):1496–1504

    Article  CAS  Google Scholar 

  4. Williams RA, Brody BL, Thomas RG, Kaplan RM, Brown SI (1998) The psychosocial impact of macular degeneration. Arch Ophthalmol (Chicago, Ill : 1960) 116(4):514–520. https://doi.org/10.1001/archopht.116.4.514

    Article  CAS  Google Scholar 

  5. Cahill MT, Banks AD, Stinnett SS, Toth CA (2005) Vision-related quality of life in patients with bilateral severe age-related macular degeneration. Ophthalmology 112(1):152–158. https://doi.org/10.1016/j.ophtha.2004.06.036

    Article  PubMed  Google Scholar 

  6. Dong LM, Childs AL, Mangione CM, Bass EB, Bressler NM, Hawkins BS, Marsh MJ, Miskala P, Jaffee HA, McCaffrey LA (2004) Health- and vision-related quality of life among patients with choroidal neovascularization secondary to age-related macular degeneration at enrollment in randomized trials of submacular surgery: SST report no. 4. Am J Ophthalmol 138(1):91–108. https://doi.org/10.1016/j.ajo.2004.02.011

    Article  PubMed  Google Scholar 

  7. Miskala PH, Hawkins BS, Mangione CM, Bass EB, Bressler NM, Dong LM, Marsh MJ, McCaffrey LD (2003) Responsiveness of the National Eye Institute Visual Function Questionnaire to changes in visual acuity: findings in patients with subfoveal choroidal neovascularization--SST Report No. 1. Arch Ophthalmol (Chicago, Ill: 1960) 121(4):531–539. https://doi.org/10.1001/archopht.121.4.531

    Article  Google Scholar 

  8. Clemons TE, Chew EY, Bressler SB, McBee W, Age-Related Eye Disease Study Research G (2003) National Eye Institute Visual Function Questionnaire in the Age-Related Eye Disease Study (AREDS): AREDS Report No. 10. Arch Ophthalmol (Chicago, Ill: 1960) 121(2):211–217. https://doi.org/10.1001/archopht.121.2.211

    Article  Google Scholar 

  9. Lindblad AS, Clemons TE (2005) Responsiveness of the National Eye Institute Visual Function Questionnaire to progression to advanced age-related macular degeneration, vision loss, and lens opacity: AREDS Report no. 14. Arch Ophthalmol (Chicago, Ill : 1960) 123(9):1207–1214. https://doi.org/10.1001/archopht.123.9.1207

    Article  Google Scholar 

  10. Coleman AL, Yu F, Ensrud KE, Stone KL, Cauley JA, Pedula KL, Hochberg MC, Mangione CM (2010) Impact of age-related macular degeneration on vision-specific quality of life: follow-up from the 10-year and 15-year visits of the Study of Osteoporotic Fractures. Am J Ophthalmol 150(5):683–691. https://doi.org/10.1016/j.ajo.2010.05.030

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ambati J, Fowler BJ (2012) Mechanisms of age-related macular degeneration. Neuron 75(1):26–39. https://doi.org/10.1016/j.neuron.2012.06.018

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kandasamy R, Wickremasinghe S, Guymer R (2017) New treatment modalities for geographic atrophy. Asia Pac J Ophthalmol (Phila) 6(6):508–513. https://doi.org/10.22608/APO.2017262

    Article  CAS  Google Scholar 

  13. Velez-Montoya R, Oliver SC, Olson JL, Fine SL, Quiroz-Mercado H, Mandava N (2014) Current knowledge and trends in age-related macular degeneration: genetics, epidemiology, and prevention. Retina 34(3):423–441. https://doi.org/10.1097/IAE.0000000000000036

    Article  CAS  PubMed  Google Scholar 

  14. Sivaprasad S, Tschosik E, Kapre A, Varma R, Bressler NM, Kimel M, Dolan C, Silverman D (2018) Reliability and construct validity of the NEI VFQ-25 in a subset of patients with geographic atrophy from the phase 2 Mahalo study. Am Jof Ophthalmol 190:1–8. https://doi.org/10.1016/j.ajo.2018.03.006

    Article  Google Scholar 

  15. Rein DB, Wittenborn JS, Zhang X, Honeycutt AA, Lesesne SB, Saaddine J, Vision Health Cost-Effectiveness Study G (2009) Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments. Arch Ophthalmol (Chicago, Ill : 1960) 127(4):533–540. https://doi.org/10.1001/archophthalmol.2009.58

    Article  Google Scholar 

  16. Age-Related Eye Disease Study Research G (1999) The Age-Related Eye Disease Study (AREDS): design implications. AREDS report no. 1. Control Clin Trials 20(6):573–600

    Article  Google Scholar 

  17. Chew EY, Clemons TE, Agrón E, Sperduto RD, Sangiovanni JP, Davis MD, Ferris FL 3rd (2014) Ten-year follow-up of age-related macular degeneration in the age-related eye disease study: AREDS report no. 36. JAMA Ophthalmol 132(3):272–277. https://doi.org/10.1001/jamaophthalmol.2013.6636

    Article  PubMed  Google Scholar 

  18. Orr P, Rentz AM, Margolis MK, Revicki DA, Dolan CM, Colman S, Fine JT, Bressler NM (2011) Validation of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in age-related macular degeneration. Invest Ophthalmol Vis Sci 52(6):3354–3359. https://doi.org/10.1167/iovs.10-5645

    Article  PubMed  Google Scholar 

  19. National Center for Biotechnology Information (NCBI) database of Genotypes and Phenotypes (dbGaP) National Eye Institute (NEI) Age-Related Eye Disease Study (AREDS). dbGaP Study Accession: phs000001v3p1 2016. Bethesda: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000001.v3.p1. Accessed 15 Nov 2019

  20. Davis MD, Gangnon RE, Lee LY, Hubbard LD, Klein BE, Klein R, Ferris FL, Bressler SB, Milton RC, Age-Related Eye Disease Study G (2005) The Age-Related Eye Disease Study severity scale for age-related macular degeneration: AREDS Report No. 17. Arch Ophthalmol (Chicago, Ill : 1960) 123(11):1484–1498. https://doi.org/10.1001/archopht.123.11.1484

    Article  Google Scholar 

  21. Kong X, Strauss RW, Cideciyan AV, Michaelides M, Sahel JA, Munoz B, Ahmed M, Ervin AM, West SK, Cheetham JK, Scholl HPN, ProgStar Study G (2017) Visual acuity change over 12 months in the prospective progression of atrophy secondary to stargardt disease (ProgStar) study: ProgStar Report Number 6. Ophthalmology 124(11):1640–1651. https://doi.org/10.1016/j.ophtha.2017.04.026

    Article  PubMed  Google Scholar 

  22. Davis LJ, Schechtman KB, Wilson BS, Rosenstiel CE, Riley CH, Libassi DP, Gundel RE, Rosenberg L, Gordon MO, Zadnik K, Collaborative longitudinal evaluation of keratoconus study G (2006) Longitudinal changes in visual acuity in keratoconus. Invest Ophthalmol Vis Sci 47(2):489–500. https://doi.org/10.1167/iovs.05-0381

    Article  PubMed  Google Scholar 

  23. Shen LL, Sun M, Khetpal S, Grossetta Nardini HK, Del Priore LV (2020) Topographic variation of the growth rate of geographic atrophy in nonexudative age-related macular degeneration: a systematic review and meta-analysis. Invest Ophthalmol Vis Sci 61(1):2. https://doi.org/10.1167/iovs.61.1.2

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, Fahrbach K, Probst C, Sledge I (2008) The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology 115(1):116–126. https://doi.org/10.1016/j.ophtha.2007.03.008

    Article  PubMed  Google Scholar 

  25. Eid M, Diener E (2004) Global judgments of subective well-being: situational variability and long-term stability. Soc Indic Res 65(3):245–277

    Article  Google Scholar 

  26. Schippert AC, Jelin E, Moe MC, Heiberg T, Grov EK (2018) The impact of age-related macular degeneration on quality of life and its association with demographic data: results from the NEI VFQ-25 questionnaire in a Norwegian Population. Gerontol Geriatr Med 4:2333721418801601. https://doi.org/10.1177/2333721418801601

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chatziralli I, Mitropoulos P, Parikakis E, Niakas D, Labiris G (2017) Risk factors for poor quality of life among patients with age-related macular degeneration. Semin Ophthalmol 32(6):772–780. https://doi.org/10.1080/08820538.2016.1181192

    Article  PubMed  Google Scholar 

  28. Fink BA, Wagner H, Steger-May K, Rosenstiel C, Roediger T, McMahon TT, Gordon MO, Zadnik K (2005) Differences in keratoconus as a function of gender. Am J Ophthalmol 140(3):459–468. https://doi.org/10.1016/j.ajo.2005.03.078

    Article  PubMed  Google Scholar 

  29. Sorman DE, Ljungberg JK, Ronnlund M (2018) Reading habits among older adults in relation to level and 15-year changes in verbal fluency and episodic recall. Front Psychol 9:1872. https://doi.org/10.3389/fpsyg.2018.01872

    Article  PubMed  PubMed Central  Google Scholar 

  30. Astarita C, D'Angelo-Maansson B, Massaro-Giordano M, Alba MP, Boffo S, Macchi I, Giordano A, Macaluso M (2018) Effect of sex steroid hormone fluctuations in the pathophysiology of male-retinal pigment epithelial cells. J Cell Physiol 233(9):6965–6974. https://doi.org/10.1002/jcp.26486

    Article  CAS  PubMed  Google Scholar 

  31. Zetterberg M (2016) Age-related eye disease and gender. Maturitas 83:19–26. https://doi.org/10.1016/j.maturitas.2015.10.005

    Article  PubMed  Google Scholar 

  32. Tufail A, Margaron P, Guerin T, Larsen M (2019) Visual benefit versus visual gain: what is the effect of baseline covariants in the treatment arm relative to the control arm? A pooled analysis of ANCHOR and MARINA. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2018-313682

  33. Clemons TE, Gillies MC, Chew EY, Bird AC, Peto T, Figueroa M, Harrington MW, Macular Telangiectasia Research G (2008) The National Eye Institute Visual Function Questionnaire in the Macular Telangiectasia (MacTel) Project. Invest Ophthalmol Vis Sci 49(10):4340–4346. https://doi.org/10.1167/iovs.08-1749

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bressler NM, Chang TS, Suner IJ, Fine JT, Dolan CM, Ward J, Ianchulev T, Marina GAR (2010) Vision-related function after ranibizumab treatment by better- or worse-seeing eye: clinical trial results from MARINA and ANCHOR. Ophthalmology 117(4):747–756 e744. https://doi.org/10.1016/j.ophtha.2009.09.002

    Article  PubMed  Google Scholar 

  35. Ramírez Estudillo JA, León Higuera MI, Rojas Juárez S, Ordaz Vera ML, Pablo Santana Y, Celis Suazo B (2017) Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study. Int J Retina Vitreous 3(1):21. https://doi.org/10.1186/s40942-017-0071-1

    Article  PubMed  PubMed Central  Google Scholar 

  36. Nilsson UL, Frennesson C, Nilsson SE (2003) Patients with AMD and a large absolute central scotoma can be trained successfully to use eccentric viewing, as demonstrated in a scanning laser ophthalmoscope. Vision Res 43(16):1777–1787. https://doi.org/10.1016/s0042-6989(03)00219-0

    Article  PubMed  Google Scholar 

  37. Lamoureux EL, Pallant JF, Pesudovs K, Rees G, Hassell JB, Keeffe JE (2007) The effectiveness of low-vision rehabilitation on participation in daily living and quality of life. Invest Ophthalmol Vis Sci 48(4):1476–1482. https://doi.org/10.1167/iovs.06-0610

    Article  PubMed  Google Scholar 

  38. Nickels S, Schuster AK, Singer S, Wild PS, Laubert-Reh D, Schulz A, Finger RP, Michal M, Beutel ME, Münzel T, Lackner KJ, Pfeiffer N (2017) The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) - reference data from the German population-based Gutenberg Health Study (GHS). Health Qual Life Outcomes 15(1):156. https://doi.org/10.1186/s12955-017-0732-7

    Article  PubMed  PubMed Central  Google Scholar 

  39. van der Aa HP, Xie J, Rees G, Fenwick E, Holloway EE, van Rens GH, van Nispen RM (2016) Validated prediction model of depression in visually impaired older adults. Ophthalmology 123(5):1164–1166. https://doi.org/10.1016/j.ophtha.2015.11.028

    Article  PubMed  Google Scholar 

  40. Massof RW, Fletcher DC (2001) Evaluation of the NEI visual functioning questionnaire as an interval measure of visual ability in low vision. Vision Res 41(3):397–413. https://doi.org/10.1016/s0042-6989(00)00249-2

    Article  CAS  PubMed  Google Scholar 

  41. Revicki DA, Rentz AM, Harnam N, Thomas VS, Lanzetta P (2010) Reliability and validity of the National Eye Institute Visual Function Questionnaire-25 in patients with age-related macular degeneration. Invest Ophthalmol Vis Sci 51(2):712–717. https://doi.org/10.1167/iovs.09-3766

    Article  PubMed  Google Scholar 

  42. Owen CG, Rudnicka AR, Smeeth L, Evans JR, Wormald RP, Fletcher AE (2006) Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population? BMC Ophthalmol 6:24. https://doi.org/10.1186/1471-2415-6-24

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The dataset used for the analyses described in this manuscript was obtained from the AREDS Database through dbGaP accession number phs000001.v3.p1. Funding support for AREDS was provided by the National Eye Institute (N01-EY-0-2127). We would like to thank the AREDS participants and the AREDS Research Group for their valuable contribution to this research.

Funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number T35AG049685 (Recipient: Ahluwalia) and P30 EY026878 from the National Eye Institute (NEI) (Recipient: Yale Vision Science Core).

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Science, Yale University School of Medicine, 40 Temple Street, Suite 1B, New Haven, CT, 06510, USA

    Aneesha Ahluwalia, Liangbo L. Shen & Lucian V. Del Priore

Authors
  1. Aneesha Ahluwalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liangbo L. Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucian V. Del Priore
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Aneesha Ahluwalia, Liangbo L. Shen, and Lucian V. Del Priore; Methodology: Aneesha Ahluwalia, and Liangbo L. Shen; Formal analysis and investigation: Aneesha Ahluwalia; Writing—original draft preparation: Aneesha Ahluwalia; Writing—review and editing: Aneesha Ahluwalia, Liangbo L. Shen, and Lucian V. Del Priore; Supervision: Lucian V. Del Priore.

Corresponding author

Correspondence to Lucian V. Del Priore.

Ethics declarations

Conflicts of interest

No conflicting relationship exists for any author. Lucian V. Del Priore serves as a consultant for Astellas Institute for Regenerative Medicine.

Ethics approval

This study was exempted by the Yale Institutional Review Board.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Code availability

All study analyses were performed using R 3.6.0 (R Foundation for Statistical Computing, Vienna, Austria).

Disclaimer

The sponsors or funding organizations had no role in the design or conduct of this research.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 125 kb)

ESM 2

(PDF 124 kb)

ESM 3

(PDF 216 kb)

ESM 4

(PDF 108 kb)

ESM 5

(PDF 135 kb)

ESM 6

(PDF 143 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahluwalia, A., Shen, L.L. & Del Priore, L.V. Central geographic atrophy vs. neovascular age–related macular degeneration: differences in longitudinal vision-related quality of life. Graefes Arch Clin Exp Ophthalmol 259, 307–316 (2021). https://doi.org/10.1007/s00417-020-04892-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04892-5

Keywords

Search

Navigation