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BackgroundThe macular central 1 mm diameter zone is crucial to patients’ visual acuity, but the long-term natural history of central sparing in eyes with geographic atrophy (GA) is unknown.MethodsWe manually segmented GA in 210 eyes with GA involving central 1 mm diameter zone (mean follow-up=3.8 years) in the Age-Related Eye Disease Study. We measured the residual area in central 1 mm diameter zone and calculated central residual effective radius (CRER) as square root of (residual area/π). A linear mixed-effects model was used to model residual size over time. We added a horizontal translation factor to each data set to account for different durations of GA involving the central zone.ResultsThe decline rate of central residual area was associated with baseline residual area (p=0.008), but a transformation from central residual area to CRER eliminated this relationship (p=0.51). After the introduction of horizontal translation factors to each data set, CRER declined linearly over approximately 13 years (r2=0.80). The growth rate of total GA effective radius was 0.14 mm/year (95% CI 0.12 to 0.15), 3.7-fold higher than the decline rate of CRER (0.038 mm/year, 95% CI 0.034 to 0.042). The decline rate of CRER was 53.3% higher in eyes with than without advanced age-related macular degeneration in the fellow eyes at any visit (p=0.007).ConclusionsCRER in eyes with GA declined linearly over approximately 13 years and may serve as an anatomic endpoint in future clinical trials aiming to preserve the central zone.

Purpose This study used the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument to evaluate the methodological quality of clinical practice guidelines (CPG) published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS) and Royal College of Ophthalmologists (RCO) for the management of cataract in adults. Study design An evaluation of the AAO, COS and RCO CPGs using a reliable and validated instrument. Methods Four evaluators independently appraised the three CPGs using the AGREE II Instrument, which covers six domains (Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability and Editorial Independence). The AGREE II includes an Overall Assessment summarising guideline methodological rigour across all domains, using a 7-point scale where perfect adherence equals a score of 7. Results Scores ranged from 36% to 75% for the AAO guideline; 45% to 94% for the COS guideline and 23% to 85% for the RCO guideline. Intraclass correlation coefficients for the reliability of mean scores for the AAO, COS, and RCO were 0.78, 0.74 and 0.80; 95% CIs (0.60 to 0.90), (0.45 to 0.88) and (0.53 to 0.91), respectively. The strongest domains were Scope and Purpose (COS, RCO), Clarity of Presentation (COS, RCO) and Editorial Independence (AAO, COS). The weakest were Stakeholder Involvement (AAO), Applicability (AAO, COS) and Editorial Independence (RCO). Conclusions Cataract surgery practice guidelines can be improved by targeting stakeholder involvement, applicability and editorial independence.