Percentage of Foveal vs Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degeneration

Purpose: This article investigates the relationship between visual acuity (VA), total area of geographic atrophy (GA), and percentage of foveal GA.Methods: A multicenter, retrospective, cross-sectional study was conducted of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT) images were collected. Using FAF images aided by SD-OCT, fovea-sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area—within a 1.5-mm-diameter circle centered on the fovea centralis—were assessed. Univariable and multiple linear regression analyses were performed.Results: Fifty-four eyes (mean age, 78.7 ±7.7 years [SD], 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logarithm of the minimum angle of resolution (Snellen equivalent 20/126 ± 20/80), mean total GA 8.8 ± 6.7 mm2, and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P= .004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P= .440).Conclusions: Percentage of foveal GA was significantly associated with VA impairment, although the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.