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. 2023 Feb;12(1):325-340.
doi: 10.1007/s40123-022-00583-y. Epub 2022 Nov 11.

Dry Age-Related Macular Degeneration: Distribution of Visual Acuity and Progression Risk in a Large Registry

Theodore Leng  1 , Jason Schwartz  2 , David Nimke  2 , Mark Gallivan  3   4 , Helene Fevrier  3 , Nigel Rozario  2 , Neil M Schultz  5
Affiliations

Dry Age-Related Macular Degeneration: Distribution of Visual Acuity and Progression Risk in a Large Registry

Theodore Leng et al. Ophthalmol Ther. 2023 Feb.

Abstract

Introduction: Understanding the progression to geographic atrophy (GA) in late dry age-related macular degeneration (dAMD) can support development opportunities for dAMD treatments. We characterized dAMD by distribution of visual acuity (VA) categories and evaluated VA progression risk by disease stage.

Methods: This retrospective observational study used data from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) to identify patients diagnosed with dAMD in ≥ 1 eye from January 2016 through December 2019 (index date) with ≥ 1 visit and ≥ 1 VA measurement recorded post-index date. Patients were followed until the date of last visit, last contribution for diagnosing provider, or diagnosis of neovascular AMD post-index. Models were utilized to describe the distribution of VA categories and progression to worsening VA.

Results: Data from 593,277 patients were analyzed. At baseline, 64.4% had mild disease, 29.4% intermediate, and 2.9%/3.3% had GA with/without subfoveal involvement. Most patients with mild (88.4%) and intermediate (79.7%) disease and GA without subfoveal involvement (57.1%) had baseline VA ≥ 20/63 in the study eye; 72.0% of patients with GA with subfoveal involvement had VA < 20/63. Modeled results showed lower VA with more progressive stage at baseline. Annual probability of stable dAMD based on baseline stage ranged from 82.1% (GA without) to 92.3% (GA with subfoveal involvement). Annual progression probability to GA without/with subfoveal involvement was 0.4% for mild and 5.5% for intermediate disease and from dry to neovascular AMD, 0.5% for mild and 8.0% for intermediate disease.

Conclusions: Results from this analysis of a large database of electronic health records complement those from randomized trials and show that patients with more advanced dAMD have lower VA at baseline and that VA progression is generally faster with each progressive stage. Together these findings highlight the disease burden and trajectory of dAMD as well as opportunities for addressing unmet needs.

Keywords: Epidemiology; Geographic atrophy; Markov model; Visual acuity.

Plain language summary

Dry age-related macular degeneration (dAMD) is a disease that progressively worsens over time. As the disease progresses, patients start to lose their vision, leading to a substantial burden on their quality of life and finances due to the need for increased healthcare services. As of 2022, there are no medications available to reverse or stop worsening of dAMD. This study used real-world data from a large registry of electronic health records to increase the understanding of how patients progress through the stages of dAMD. By reviewing patient records, we were able to identify approximately 600,000 patients with confirmed dAMD. These patients were then followed over time, and we were able to confirm that patients with a lower ability to see at the beginning of our review period had more advanced dAMD. We also found that as patients’ disease worsened, their vision also decreased. These findings highlight the need for new medication options to reverse or delay the worsening of dAMD and improve the quality of life for patients.

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Figures

Fig. 1
Fig. 1
Study design. AMD age-related macular degeneration, HRU healthcare resource utilization, VA visual acuity
Fig. 2
Fig. 2
Patient flow diagram. AMD age-related macular degeneration, ICD International Classification of Diseases, VA visual acuity
See this image and copyright information in PMC

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