Researchers have determined that non-geographic atrophy is common in eyes treated with anti-VEGF for wet AMD and many progress to geographic atrophy (GA) within four years of onset. This post-hoc analysis of participants in the Comparison of Age-related Macular Degeneration Treatment Trials (CATT) defines non-geographic atrophy as hypo- and hyperpigmentation in color fundus images.
During the initial CATT trial, researchers randomized 1,107 participants to two groups receiving ranibizumab or bevacizumab: one group received treatment for two years of monthly or as-needed injections and the other received monthly injections for one year and then as-needed for the following year.
The team found that the risk for nongeographic atrophy at one, two and five years was 35%, 59% and 81%, respectively. The study found the risks for non-geographic atrophy were worse visual acuity (20/200 to 20/320 compared with ≤20/40), larger neovascularization area (>4 disc areas compared with ≤1 disc areas), switched drug regimen compared with as-needed injections and the presence of a few single-nucleotide variants.
When analyzing 389 eyes that developed nongeographic atrophy by two years, the researchers discovered that risk of progression to GA was 29%, 43% and 50% at one, three and four years, respectively. The risk factors for progression to GA included worse visual acuity (20/200 to 20/320 compared with ≤20/40), worse fellow-eye visual acuity (<20/40 compared with ≥20/40), fellow-eye GA and pseudodrusen in either eye. The study also noted that subretinal fluid was associated with a decreased risk of progression.
Daniel E, Maguire MG, Grunwald JE, et al. Incidence and progression of nongeographic atrophy in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Clinical Trial. JAMA Ophthalmol. March 19, 2020. [Epub ahead of print].