Author: Daniel Jones (United States)
Co-authors: Meryem Bektas, Anne Heyes, Samantha Wronski, Sujata Sarda
Geographic atrophy (GA) is the advanced form of dry age-related macular degeneration that can result in irreversible blindness over time. There are no approved therapies for GA and currently no methods available to prevent or slow progression, estimate risk, or determine the prognosis of GA. Though not well understood, studies in the US estimate incidence at about 1.9 per 1,000 (95% credible interval [CrI], 1.3-2.8). In those aged 65 years and older, the annual incidence rate for GA was 4.3 per 1,000 (95% CrI, 2.9-6.2). An estimated 12% to 20% of patients with GA have severe vision loss, which can render patients dependent on caregivers who provide help with transportation and daily household chores. We performed a systematic literature review to assess the clinical and humanistic burden of GA.
A systematic literature review of data published between January 1, 2015 and August 11, 2020
A systematic literature review was conducted using predefined search terms to identify studies in electronic databases including PubMed, Embase, and Cochrane Library from January 1, 2015 to August 11, 2020. In addition, conference abstracts from the previous year (2019-2020) were searched to identify recent information not yet indexed in medical literature databases.
An estimated 12% to 20% of patients with GA have severe vision loss, and 31% lose at least three lines of vision in 2 years. Vision-related function and health-related quality of life are poor in patients with GA versus individuals without GA. In prospective trials, health-related quality of life is commonly measured using the validated instrument, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Patients with GA have significantly lower NEI VFQ-25 composite scores and lower subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision versus individuals without GA. Driving is a particular concern, and inability to drive affects dependency. GA is associated with increased risks of anxiety and depression, likely due to patients' inability to care for themselves and from interference of visual loss with daily tasks. Patients are more likely to experience falls and fractures as a result of their impaired vision; in one study, approximately 9% of patients with GA had a fall or fracture during a 12-month period.
GA is associated with significant clinical and humanistic burdens, and loss of vision has a detrimental effect on many aspects of patients' lives. Further research is recommended to better understand the burden of GA on patients.
Daniel Jones, PhD and Sujata P Sarda, PhD, MS are employees of Apellis Pharmaceuticals