David Haselwood | Visual Function Abnormalities and Prognosis in Eyes with Age-related Geographic Atrophy of the Macula and Good Visual Acuity

Purpose: Geographic atrophy (GA) may cause significant compromise of visual function, even when there still is good visual acuity (VA), because of parafoveal scotomas and foveal function abnormalities antedating visible atrophy. This study evaluates the visual function abnormalities at baseline and the 2-year worsening of VA and reading rate for eyes with GA compared with a group of eyes with drusen only.

Methods: Seventy-four eyes with GA and VA greater than or equal to 20/50 from a prospective natural history study of GA were included, as were 13 eyes with only drusen. Baseline visual function testing and 2-year VA and maximum reading rate are reported.

Results: The worsening of VA in decreased luminance and foveal dark-adapted sensitivity showed severe abnormalities for the GA group. Contrast sensitivity was significantly reduced for the eyes with GA. Half the eyes with GA, but none of the drusen eyes, had maximum reading rates below 100 words per minute. A scanning laser ophthalmoscope (SLO) measure of the scotoma near fixation combined with a measure of residual foveal function accounted for 54% of the variability in maximum reading rate in the eyes with GA.

Of 40 eyes with GA observed for 2 years, half lost greater than or equal to 3 lines of VA and one quarter lost greater than or equal to 6 lines. The nine eyes with drusen with follow-up had no significant change in VA. Low foveal dark-adapted sensitivity, SLO measures of the scotoma within 1° of fixation, and low maximum reading rate were statistically significant risk factors for doubling of the visual angle. Significant reduction in maximum reading rates at 2 years was present for the eyes with GA.

Conclusions: The eyes with GA with good VA have profound decreases in visual function, particularly in dim lighting and in reading. Half the eyes with GA had doubling in visual angle at 2 years after the baseline examination, whereas the drusen eyes remained essentially unchanged. Impaired visual function at baseline was predictive of an adverse outcome for the eyes with GA.

The baseline visual function abnormalities were presented at the 1995 meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida. The natural history aspect of this article is being submitted as an abstract for presentation at the 1997 American Academy of Ophthalmology Meeting, San Francisco, California.

Supported by NEI grants R01EY08552 (JS, CA, NB, BH, MM, DH) and RO1EY06380 (GR, JS).

The work with the scanning laser ophthalmoscope has been supported in part by the Harry and Jeanette Weinberg Foundation, Baltimore, Maryland; the Morris Rodman Philanthropic Foundation, Rockville, Maryland; the Altsheler-Durell Foundation, Louisville, Kentucky; the Grousbeck Family Foundation, Boston, Massachusetts; and the Macula Foundation, New York, New York.

The authors have no proprietary interest in the development or marketing of instruments used in this study or in competing instruments. Read More......