Work

Geographic Atrophy Size Progression Correlates Better with Longitudinal Changes in Quantitative Contrast Sensitivity than Visual Acuity

Year: 2026

Type: article

Abstract: Purpose Investigate the cross-sectional and longitudinal correlations between total geographic atrophy (GA) size and quantitative contrast sensitivity function (qCSF). Design Prospective, cross-sectional, and longitudinal observational study between November 2018 and March 2023 at Massachusetts Eye and Ear. Subjects A total of 83 foveal involving GA eyes cross-sectionally and 30 foveal involving GA eyes longitudinally. Methods Contrast sensitivity (CS) was measured with the qCSF device along with same day spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). GA was defined as hypoautofluorescent lesions on FAF corresponding to complete RPE and outer retinal atrophy on SD-OCT. Total GA size was measured on FAF using the semiautomatic Heidelberg Region Finder tool. Mixed effects multivariate regression models were performed to evaluate correlations between GA size, qCSF metrics, and visual acuity (VA). Main Outcome Measures Total GA size, longitudinal changes in total GA size, qCSF outcomes (Area under the Log CSF (AULCSF), contrast acuity (CA), contrast sensitivity (CS) thresholds at 1-18 cycles per degree (cpd)) and longitudinal changes in qCSF outcomes. Results Cross-sectionally (n=83), total GA was associated with multiple qCSF outcomes including AULCSF and CS thresholds at 1, 1.5, 3, 6, and 12cpd (β= -0.23 to -0.39, all p<0.05), but was not associated with VA (β=0.08, p=0.47). At 17.2 months follow up (range: 6-37) (n=30), an average increase of 1 mm 2 in total GA size was associated with a non-statistically significant decrease of 0.01 in VA (p= 0.88), but a statistically significant decrease in contrast sensitivity (-0.05 for AUCLSF, -0.05 for CA, -0.04 for 1cpd, -0.05 for 1.5 cpd, and -0.06 for 3cpd, all p<0.05). Standardized regression coefficients suggest that the statistically significant decrease in contrast sensitivity metrics per mm 2 of GA size increase are 11-20 fold bigger compared to the non-statistically significant decrease in VA. (-0.33 to -0.62 for qCSF versus -0.03 for VA). Conclusions Total GA and longitudinal change in GA size were found to be associated with significant changes in qCSF contrast sensitivity, but not with VA or change in VA. Contrast sensitivity seems to be a better functional endpoint to measure treatment effects in GA.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101206