Visual Functioning and Progression from Intermediate Age-Related Macular Degeneration (AMD) to Advanced AMD

Purpose To investigate whether the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) can predict the progression of intermediate age-related macular degeneration (iAMD) to advanced non-neovascular (NNV) or neovascular (NV).Methods 380 patients aged 55–99 years with iAMD in one or both eyes and no evidence of geographic atrophy (GA) or NV AMD in either eye were enrolled (2014–2023 into the University of Colorado AMD registry) with follow-up through November 2024. AMD classification and progression were based on multimodal imaging review by two vitreoretinal surgeons. Baseline visual acuity (LogMAR) and VFQ-25 scores were collected at enrollment. Cox proportional hazards models assessed time to progression. Kaplan-Meier analysis evaluated significant VFQ-25 subscales.Results Among 380 iAMD participants (mean age 76.1 years, 95.8% white), 131 (34.5%) progressed to advanced AMD over a median 32-month follow up (SD- 27). Worse baseline LogMAR in both the better- (HR: 6.39, 95% CI: 1.57–26; p = 0.001) and worse- (HR: 2.64, 95% CI: 1.26–5.55; p = 0.010) seeing eyes predicted progression. Lower baseline VFQ-25 general vision (HR: 0.84 per 10-point increase, 95% CI: 0.74–0.95, p = 0.006) and distance activities scores (HR: 0.89 per 10-point increase, 95% CI: 0.80–0.98, p = 0.019) predicted progression during follow-up. In multivariable analysis adjusting for age and LogMAR for both eyes, this remained significant for general vision (HR: 0.85, 95% CI:0.75–0.98, p = 0.022). Kaplan-Meier analysis showed faster progression for patients with baseline general vision and distance activity subscores below 85 (p = 0.013 and p = 0.011, respectively).Conclusion Lower NEI-VFQ-25 general vision subscale scores independently predicted progression to advanced AMD.