Study Highlights Association Between Lesion Location and Vision-related QoL in GA

A large study suggests clinicians and researchers should evaluate atrophy throughout the central 2.5mm region, because focusing only on foveal involvement underestimates the structural changes that drive self‑reported reductions in visual function. Photo: Paul M. Karpecki, OD. Click image to enlarge. Given that patients with geographic atrophy (GA) are likely to experience visual function loss, slowing this decline is the ultimate goal of modern treatments. Researchers recently acknowledged a gap in the literature regarding how the topography of GA lesions correlates to vision-related quality of life (VR-QoL). Two previous studies evaluated this relationship, though their cohorts were small and the findings were conflicting. This led investigators to conduct a larger, international study to define which topographic distribution of GA relates most closely to self‑reported visual functioning. They concluded that the extent of atrophy within the central 2.5‑mm diameter around the fovea was most strongly associated with worse VR-QoL, suggesting that structural damage in this broader central zone—not only foveal involvement—may best explain patient-reported visual difficulties and should be a focus for monitoring and treatment decisions.The National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) was used to estimate VR-QoL in a cohort of 856 adults with bilateral GA from 23 countries. All participants were aged 50 or older (median age: 78), and 62% were female. GA was segmented automatically on fundus autofluorescence and near‑infrared reflectance images using a deep learning model; foveal locations were mapped from co‑registered OCT. GA extent was calculated as the percent area within concentric regions centered on the fovea from 0.25mm to 6.00mm (0.25mm steps). The findings, published earlier this week in Ophthalmology, demonstrate that across central regions from 0.25mm to 6.00mm, the minimum GA extent (the lower value of the two eyes within an individual) was significantly associated with NEI VFQ‑25 person measures. According to the researchers, this indicates “that most of the explanatory effect for VR-QoL is dominated by the ‘better’ eye.” The central 2.50mm diameter region showed the strongest association, explaining 11% of variance in the visual‑function domain and 4% in the socioemotional domain. In multivariable models, only the minimum GA extent inside the central 2.5mm was independently associated with worse VR‑QoL.“Evaluation of GA extent within the central 2.5mm diameter region in both future GA clinical trials and in clinical practice could thus capture the structural changes that most closely correlate with self-reported functional impairment,” the researchers concluded in their paper.Click here for the journal source. Anegondi N, Lam D, Guymer RH, et al. Vision-related quality of life in geographic atrophy: association with topographic lesion distribution. Ophthalmology. April 22, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.