Risk score for geographic atrophy

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Feb 26, 2012, 11:15:10 PM2/26/12

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Researchers have developed a risk score for developing geographic
atrophy (GA) involving easily obtainable information among patients
with bilateral large drusen.

Choroidal neovascularization (CNV) and geographic atrophy (GA) are two
forms of end-stage AMD. GA is responsible for about 10% of the severe
vision loss attributed to the AMD, and affects approximately 900,000
persons in the United States. Anti-vascular endothelial growth factor
(Anti-VEGF) therapy has been proven to be highly effective in reducing
the vision loss in patients with CNV. Although several agents to
prevent the development or arrest the progression of GA are currently
under investigation in clinical trials, none have yet been shown to be
effective.

GA progresses gradually over time, and the causes of GA are largely
unknown. However, data from large observational studies and clinical
trial cohorts have consistently identified age, current smoking
status, hypertension, drusen size or area, and pigmentary changes as
risk factors. Recent investigations have identified genes associated
with GA, including Complement Factor H, Complement Factor B, LOC387715
and Complement C3 variant. More recently, night vision as assessed by
a 10-item questionnaire was found to be highly predictive of the
development of GA, independent of other established risk factors.

Methods & Results

The study included 1052 participants from the Complications of
Age-related Macular Degeneration (AMD) Prevention Trial (CAPT) with =
10 large (>125 µm) drusen and visual acuity ≥20/40 in each eye.

In the Complications of Age-related Macular Degeneration (AMD)
Prevention Trial (CAPT), 1 eye of each participant was randomly
assigned to laser treatment and the contralateral eye was assigned to
observation to evaluate whether laser treatment of drusen could
prevent vision loss. Gradings by a reading center were used to
identify: CAPT end point GA (total area of GA [>250 µm] > 1 disc
area), GA (>175 µm) involving the foveal center (CGA), and GA of
any size and location (any GA). Established risk factors (age, smoking
status, hypertension, Age-related Eye Disease Study simple severity
scale score), both with and without a novel risk factor (night vision
score), were used in assigning risk points. The risk scores were
evaluated for the ability to discriminate and calibrate GA risk.

Among 942 CAPT participants who completed 5 years of follow-up and did
not have any GA at baseline, 6.8% participants developed CAPT end
point GA, 9.6% developed CGA, and 34.4% developed any GA. The 5-year
incidence of end point GA in 1 or both eyes of a participant increased
with the 15-point GA risk score, from 0.6% for

Ophthalmology. 2011 Feb;118(2):332-8

http://www.ncbi.nlm.nih.gov/pubmed/20801521

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