Progression of Loss of Vision From Centre‐Involving Macular Atrophy in Eyes Treated for nAMD

Background This study aimed to characterise visual acuity (VA) changes in eyes without baseline macular atrophy (MA) that subsequently developed MA during treatment for neovascular age‐related macular degeneration (nAMD). Methods A case–control analysis was performed using data from a multicentre real‐world AMD registry. We compared VA outcomes in 1998 treatment‐naïve eyes without MA at baseline and ≥ 5 years of follow‐up. Two matched groups (999 eyes each) were analysed: eyes that developed incident MA and those that never did. Results Comparisons were made between two matched groups of 999 eyes each with incident MA and those that never developed it with at least 5 years of follow‐up. Final VA was best in eyes that never developed MA, followed by eyes that developed extrafoveal and sub‐foveal MA (68.9 ± 16.7, 67.0 ± 16.9 and 52.1 ± 23.6 letters, p < 0.01). Eyes with incident MA had more inactive disease visits compared to those that never developed MA. Features associated with poor final VA included the presence of sub‐foveal MA (odds ratio [OR] [95% confidence interval (CI)] −16.63 [−18.7 to 14.56], p < 0.01) and a higher proportion of active visits (per 10%) (OR [95% CI] −0.73 [−1.12 to 0.34], p < 0.01). The mean time to lose five letters of vision from first grading of sub‐foveal MA was 17.3 ± 4.6 months. Conclusion It is important to achieve disease inactivity in nAMD despite its association with incident MA, as neovascular complications play a significant role in VA loss. The long duration between the incidence of MA and clinically significant loss of vision offers an opportunity for potential interventions against atrophy.