Changes in Vision-Related Quality of Life before and after Geographic Atrophy Development in Age-Related Eye Disease Study Participants

TL;DR

This study found that vision-related quality of life declines more rapidly after noncentral geographic atrophy develops in patients with age-related macular degeneration.

Contribution

The study introduces a novel analysis of quality of life changes specifically before and after geographic atrophy subtypes development in AMD patients.

Findings

Quality of life declined more rapidly after noncentral GA compared to before GA onset.

Central GA development was not associated with significant changes in quality of life measures.

The findings suggest subtype-specific impacts on vision-related quality of life in AMD.

Abstract

To examine for change in vision-related quality of life before and after geographic atrophy (GA) development.

A post hoc analysis of a prospective randomized clinical trial.

Age-Related Eye Disease Study (AREDS) participants with ≥2 study visits 1 year apart at which they completed the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) and age-related macular degeneration (AMD) severity gradings available at the VFQ visits.

A masked reading center assessed AMD severity using annual color fundus photographs. Regression spline models with random effects for time and eye-within-participant (SAS 9.4) were used to compare the rate of change in quality of life (difference in slope for each of the 4 quality of life measures) before and after development of GA (with separate models for GA subtypes: central GA [CGA], noncentral GA [NCGA], and any GA). Models were adjusted for age and visual acuity. If neovascular AMD developed after a GA outcome, we censored the subsequent observations.

Outcomes included the VFQ composite score calculated as an average score of nonmissing answered items. The method of successive dichotomizations was used to estimate person measures for the overall NEI VFQ-25 and for 2 derived subscales: visual functioning and social-emotional functioning.

Among AREDS participants with NEI VFQ-25 data available, 358 eyes (298 participants) developed any GA. None of the quality of life measures differed significantly pre- and post-CGA. Rasch-calibrated subscale score for visual function and composite scores declined more quickly after NCGA (difference in slope [post minus pre]: –0.10 logit/yr [95% confidence interval: –0.18, –0.01], P = 0.03; –0.78 points/yr [95% confidence interval: –1.47, –0.08], P = 0.03, respectively) and after any GA (–0.09 logit/yr [95% confidence interval: –0.16, –0.01], P = 0.02; –0.68 points/yr [95% confidence interval: –1.29, –0.07], P = 0.03, respectively).

We observed worsening quality of life after development of NCGA and any GA in AREDS participants across several quality of life measures. Development of CGA was not associated with any significant changes in the quality of life measures, possibly due to the smaller sample size and limited power. Our findings highlight the importance of examining the relationship between GA subtypes and different indices of quality of life.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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