PURPOSE: Geographic atrophy (GA) is an advanced form of dry age-related macular degeneration that can result in irreversible blindness over time. There are no approved therapies for GA and no methods available to prevent or slow progression, estimate risk, or determine the prognosis of GA We performed a systematic literature review to assess the clinical and humanistic burden of GA.
METHODS: A systematic literature review was conducted using predefined search terms to identify studies in PubMed, Embase, and Cochrane Library from January 1, 2015, to August 11, 2020. Desktop searches were also conducted to identify recent information not yet indexed in medical literature databases.
RESULTS: 997 unique records were identified from database and desktop searches. 604 were excluded at level 1 screening, 174 were excluded at level 2 screening, and 130 sources were included. Prevalence is not yet well understood but has been reported as 0.22% in Asia in individuals aged ≥ 40 years and 2.0% in individuals aged ≥65 years in a large Danish study. An estimated 12%-20% of patients with GA have severe vision loss, and 31% lose at least three lines of vision in 2 years. Vision-related functioning and health-related quality of life are poor in patients with GA; in prospective trials, health-related quality of life is commonly measured using the National Eye Institute Visual Function Questionnaire, and patients with GA have significantly lower composite scores and lower subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision compared with individuals without GA. Driving is a particular concern, and inability to drive affects dependency. GA is associated with an increased risk of anxiety and depression, likely due to patients’ inability to care for themselves and from interference of visual loss with daily tasks. Patients are more likely to experience falls and fractures as a result of their impaired vision; in one study, approximately 9% of patients with GA had a fall or fracture during a 12-month period.
CONCLUSIONS: GA is associated with a significant clinical and humanistic burden, and loss of vision has a detrimental effect on many aspects of patients’ lives. Further research is recommended to better understand the burden of GA on patients.
