Atrophy Advisor: A Clinical Tool for Dry Macular Degeneration with Geographic Atrophy

Abstract

Objective: To develop and evaluate Atrophy Advisor, a clinical decision tool integrating geographic atrophy (GA) progression and personalized lifespan estimates to help clinicians considering complement factor inhibitor injections for dry macular degeneration with GA.

Design: Retrospective cohort study.

Subjects: Fifty consecutive patients with GA secondary to nonexudative age-related macular degeneration, seen at Wake Forest-affiliated retina clinics from May 2013 to June 2025.

Methods: Fundus images at two or more timepoints were analyzed using ImageJ to measure the distance from the fovea to the nearest GA edge. Pixel-to-micron conversion was made using an assumed vertical disk diameter of 1800 microns. Demographics, comorbidities, and corrected visual acuities were extracted from records. Lifespan estimates were calculated using University of Connecticut (UCONN) and Social Security Administration (SSA) algorithms and compared to observed outcomes.

Main outcome measures: GA edge-to-fovea distance, GA progression rate, corrected visual acuity, and predicted versus observed lifespan.

Results: Median age was 78 years (IQR: 73.8-82.3); 64% were female. Baseline median GA-to-fovea distance was 792 µm (IQR: 509-1213 µm), declining to 395 µm (IQR: 194-702 µm) at last follow-up. Median GA progression was 122 µm/year (range 2-627 µm/year), with a direct relationship between initial distance and progression rate (p=0.006, R²=0.146). Lifespan calculators (UCONN and Atrophy Advisor) yielded median estimates of 11.9 and 11 years, respectively, influencing treatment guidance in 4% of cases.

Conclusions: Atrophy Advisor is feasible for combining GA progression kinetics and lifespan estimates to inform treatment decisions. Variability in progression rates and lifespan predictions highlights the need for personalized approaches. Limitations include measurement variability and retrospective design; future studies should validate the tool in larger, prospective cohorts.

Keywords: Age related macular degeneration; complement factor inhibitors; expected life span; geographic atrophy; personalized therapy.