Multimodal Evaluation of Visual Function in Geographic Atrophy versus Normal Eyes

Abstract

Purpose: To comprehensively evaluate visual function in eyes with geographic atrophy (GA) as compared to normal eyes.

Patients and methods: Sixty-three eyes from 63 patients ≥50 years old were recruited for this observational study; 31 were identified as normal macular health eyes and 32 with GA. Visual function was tested with best corrected visual acuity (BCVA), low luminance visual acuity (LLVA), low luminance deficit (LLD), reading speed, macular integrity microperimetry, fixation stability, and contrast sensitivity function (CSF). Anatomic function was evaluated with spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). Quality of life and vision were assessed with the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25).

Results: Visual function and quality of life are reduced in patients with GA. Moderate and strong correlations in the GA group were found between maximum reading speed (r = 0.787) (p˂0.01), CS spatial frequency 3 cpd (r = 0.441) (p˂0.05), CS spatial frequency 6 cpd (r = 0.524) (p˂0.01), fixation P1 (r = 0.379) (p˂0.05), macular sensitivity (r = 0.484) (p˂0.05) and atrophic area (r = -0.689) (p˂0.01), and the VFQ-25 composite score.

Conclusion: The decreased visual function is reflected in a poor quality of life in patients with GA. Reading speed, contrast sensitivity, fixation, and macular sensitivity are strongly associated with vision-related quality of life. The results suggest the importance of the reading letter size in patients with GA. Microperimetry and reading speed are useful tools to better assess visual impairment in patients with GA.

Keywords: age-related macular degeneration; geographic atrophy; quality of life; reading speed; visual function.

Figure 1

Reading speed in patients with geographic atrophy (GA) and control group (CG) Maximum reading speed (0.9 logRAD for GA and 0.8 logRAD for CG) corresponds to the critical point size (CPS). Error bars represent 95% confidence interval.

Figure 2

Contrast sensitivity in patients with geographic atrophy (GA) and control group (CG). Error bars represent 95% confidence interval.

Figure 3

Autofluorescence in a patient with geographic atrophy (GA) (left), Microperimetry (right), and Histogram of Macular sensitivity and Fixation stability (below) from the same patient. There are dark areas of hypo-autofluorescence corresponding to GA on the left. On the right, the black points correspond to no sensitivity and the red points correspond to decreased sensitivity on the macular sensitivity map. There is central fixation but relatively unstable fixation (below).