New study findings published in BMC Ophthalmology evaluated the changes in visual acuity (VA) after the reabsorption of subfoveal pigment epithelial detachments (PEDs) and the resultant occurrence and rate of central geographic atrophy (GA) expansion.
Talk about the study.
In this retrospective study analyzing patients with GA following reabsorption of pigment epithelial detachment (GARPED), investigators filtered the database of a retina-only practice for patients between 2007 and 2020 with records that indicated they had a subfoveal PED with ensuing central GA.
The study cohort consisted of 22 eyes from 19 participants, with an average age of 86.9 years (range 58-98 years) at reabsorption.
Tell me more.
Patients in this cohort underwent a comprehensive ophthalmic examination with spectral-domain optical coherence tomography (SD-OCT) at each visit.
Additionally, their VA was recorded before PED reabsorption, at the first visit following reabsorption, and then followed over time at 3-month intervals.
Findings?
Prior to PED reabsorption, the study cohort’s average VA was 20/80 and eventually declined to 20/200 (p= 0.001), with an average follow-up time of 30.2 months.
Following the initial loss of VA after reabsorption, there was no significant VA change.
Further, the researchers observed an average initial lesion size of GA of 0.987 mm2, with an average growth rate of 0.274 mm/year.
Go on…
Based on the study’s longitudinal data, investigators determined that patients who started with a drusenoid or serous PED had a dramatic reduction in vision and an area of GA that occurred where the PED was previously located.
Interestingly, these GA lesions had a slower growth rate and a smaller area of onset compared to previously recorded rates. A significant VA change was not observed following PED reabsorption.
Anything else?
Researchers found that PEDs were associated with an increased likelihood of progression to late-stage AMD, as well as an increased risk of losing more than 15 letters after PED detection.
Further, they posited that GA secondary to PED reabsorption might result from an alternative mechanism independent of the complement pathway.
Limitations?
The relatively small size, retrospective nature of the study, and reduced ability to precisely date PED resorption even with 3-month follow-up intervals were limitations of this study.
However, the results demonstrate that further research is warranted to analyze the relationship between the retinal pigment epithelium (RPE), outer retinal layers, and GA, as well as the timing of PED reabsorption.
Significance?
Due to the slow growth rate of GA recorded in this study, the investigators noted that it calls into question the pharmaceutical interventions targeting the complement cascade.
These therapies might be ineffective in slowing or preventing GA caused by PEDs that are reabsorbed since the mechanism of action could be markedly different from typical GA progression.