The influence of the topographic location of geographic atrophy on vision-related quality of life in nonexudative age-related macular degeneration

Purpose To examine associations between the topographic distribution of geographic atrophy (GA) and vision-related quality of life (VRQoL). Methods This study included 237 eyes from 161 participants in the Age-Related Eye Disease Study (AREDS). GA lesions were manually delineated with color fundus photographs obtained by the AREDS Research Group and atrophic area was measured in an Early Treatment Diabetic Retinopathy Study (ETDRS) grid. VRQoL was measured using the National Eye Institute Visual Function Questionnaire (NEI-VFQ). Area of atrophy in the ETDRS grid subfields was correlated with VRQoL by linear regression modeling. Results The average area of atrophy in the better and worse eye was 3.43mm(2) and 7.15mm(2) respectively. In multivariable analysis, VRQoL was not associated with total area of atrophy in the better eye (beta, - 0.53; 95% confidence interval [CI], - 1.11 to 0.05; P = 0.07) or worse eye (beta, 0.12; 95% CI, - 0.32 to 0.55; P = 0.59). However, area of atrophy in the central 1-mm-diameter zone of the better eye was significantly associated with VRQoL when the ETDRS subfields were examined individually (beta, - 14.57; 95% CI, - 27.12 to - 2.02; P = 0.023), grouped into quadrants (beta, - 18.35; 95% CI, - 30.03 to - 6.67; P = 0.002), inner and outer zones (beta, - 17.26; 95% CI, - 29.38 to - 5.14; P = 0.006), or vertical and horizontal zones (beta, - 18.97; 95% CI, - 30.18 to - 7.77; P = 0.001). Conclusion In patients with GA, greater area of atrophy in the central 1-mm-diameter zone of the better eye was independently associated with lower VRQoL, while total area of atrophy in the better or worse eye was not.