Geographic atrophy (GA) patients report quality of life (QoL) results on visual acuity and lesion size in a Danish cohort

Researchers at the Department of Ophthalmology, Zealand University Hospital and the University of Copenhagen, Denmark have found that Danish patients with geographic atrophy (GA) have a low vision-related quality of life measure (QoL, [VFQ-39]) and that visual acuity (BCVA) had a slightly stronger correlation to QoL, compared to atrophic lesion size.  The researchers reported an overall low score in each of the VFQ-39 subscale scores collected from GA patients. Visual acuity showed a larger effect on QoL than lesion size and this compared well with a similar German study. In terms of comorbidities, chronic obstructive pulmonary disease (COPD) was associated with a lower score in the subscale score “general health” and cardiovascular disease (CVD) was associated with a lower visual acuity, as well as in QoL reflected in the subscale scores “poor general vision,” “near activities,” and “dependency” of VFQ-39.

GA often occurs bilaterally and atrophic lesions may enlarge through the macular area and beyond. If the fovea is spared as long as possible, best-corrected visual acuity (BCVA) may permit reasonable vision however, even when lesions can expand parafoveally, daily functions such as reading, driving, cooking may be impacted due to delayed dark adaption, reduced contrast sensitivity and dense central scotomas.  In the current Danish study, researchers have aimed to evaluate what factors affects QoL measurements in patients with GA, particularly the size of GA or visual acuity and also the correlation between the presence of comorbidities, and VFQ-39-scores.  The VFQ-39 is used globally and measures vision-related quality-of-life comprising 25 items (including 14 optional item). The total score on each item ranges from 0 to 100 (where 100 represents best function) and contains 12 subscales concerning general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, colour vision, and peripheral vision.

The results of the study recruited a Danish cohort  with a mean age was 79.3 ± 7.1 years, and a total of 63% of the patients were female. 51% were former smokers and 4.3% active smokers, 47% were suffering from hypertension, 35% from cardiovascular disease (CVD), 16% of hypercholesterolemia, and 14% of chronic obstructive pulmonary disease (COPD). The best-corrected visual acuity letter score (ETDRS) in the best eye was 64.0 ± 18.4 letters, and smallest lesion of GA  was 6.6 ± 7.9 mm2 (measured by fundus autoflourescense). In their study, BCVA showed a larger effect on QoL than lesion size and, when evaluating effect size, defined by a previous study, “the correlation between “near activity” and BCVA showed a moderate effect size, and lesion size a small effect size, which was the same for “dependency” and “social function.””  In concluding the report of the visual acuity (BCVA) with a slightly stronger correlation to QoL compared to atrophic lesion size, the researchers commented that, “to our knowledge, no other studies have previously investigated the association between comorbidities, BCVA, and atrophic lesion size”, and that “CVD seems to have a negative effect on disease, as well as in VFQ-39 in several subscales, whereas COPD did not affect disease severity or vision-related subscales in VFQ-39.”