Thomas Ciulla, MD: Eyes with Geographic Atrophy Experience Meaningful Disease Burden

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A retrospective study of nearly 19,000 eyes presented at ARVO 2023 found patients with GA lost 2 lines of vision at year 3 and are at meaningful risk of nAMD.

A retrospective analysis of nearly 19,000 eyes with geographic atrophy (GA) suggested the significant disease burden of the condition, with affected eyes losing 2 lines of vision by year 3.

The analysis suggests eyes with GA and modest visual acuity impairment at baseline may be at greater risk of vision loss due to progression to subfoveal GA, while additionally at a meaningful risk of neovascular age-related macular degeneration (nAMD).

The research was presented at the 2023 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting in New Orleans, Louisiana.

“Basically, this study suggests that in clinical practice, eyes with GA are at meaningful risk of nAMD, about 25% of them converted,” Thomas Ciulla, MD, Chief Medical Advisor, Retina, Clearside Biomedical, told HCPLive at ARVO 2023. “Also in clinical practice, eyes with GA lost nearly 2 lines of visual acuity (VA) by year 3 and that’s actually a very meaningful drop in VA. What this suggests is that therapies to limit GA may have a significant impact on these patients.”

The retrospective analysis aimed to examine visual acuity (VA) changes and the rate of nAMD diagnosis in eyes with GA. Using the Vestrum Health Retina database, eligible patients diagnosed with nonexudative AMD with advanced atrophy (with and without subfoveal involvement), without an nAMD diagnosis prior to or at GA diagnosis date, in at least 1 eye were included in the study population. These individuals were examined between January 2014 - August 2022 with ≥3 years of follow-up.

A total of 23,730 eyes with GA with ≥3 years of follow-up were included in the study. Of this population, 4,972 were excluded due to a diagnosis of nAMD prior to or on the GA diagnosis date, leaving a total of 18,712 GA patient eyes. The mean baseline age was 79.3 years and 66% were women.

Over follow-up, the analysis showed 25% of eyes were diagnosed with nAMD, at 24.7 months on average (8.8% in year 1, 5.9% in year 2, 4.6% in year 3, and 6.3% beyond year 3). For those 11,125 eyes with GA which remained without nAMD, data showed the mean VA measured 59.5 letters at baseline, with a loss of 3.1 letters at year 1 (95% Ci, 2.8 - 3.3 letters; P <.0001).

Moreover, in 9,725 eyes with GA, investigators observed a loss of 6.4 letters at year 2 (95% CI, 6.1 - 6.8 letters), and in 8,870 eyes, there was a loss of 10.1 letters at year 3 (95% CI, 9.6 - 10.5 letters; P <.0001). When stratified by baseline VA, the team found eyes with VA <20/40 to 20/100 lost more letters compared to other measures.

Additionally, the mean central subfield thickness (CST) in 1,505 eyes measured 253.1µm at baseline, with a loss of 2.7 µm at year 1, 4.7 µm at year 2 (n = 1,318 eyes), and 8.3 µm at year 3 (n = 1,251 eyes).

For more insight into the analysis, watch the full interview with Ciulla at ARVO 2023 below.

Disclosures: Thomas Ciulla, MD reports a personal financial interest in Clearside Bio.


Ciulla TA, Boucher N, Aggarwal N, Harris A. Geographic Atrophy is Associated with Meaningful Disease Burden: Visual Acuity Changes and Conversion to Neovascular AMD Over 3 Years in 18,712 Patient Eyes. Presented at the 2023 Association for Research in Vision and Ophthalmology Annual Meeting; April 2023; New Orleans, LA.