MIAMI — Geographic atrophy is part of the overall age-related macular degeneration disease process and was seen in more than half of eyes with wet AMD in one study, a speaker said here.
“It’s not a different disease — it’s part of the disease,” Jason S. Slakter, MD, said at the Angiogenesis, Exudation, and Degeneration 2014 meeting. “We all know that CNV develops in patients with dry AMD — we’ve known that for years — but everyone is kind of shocked that we might get geographic atrophy in patients with CNV, although we probably shouldn’t have been surprised. In the past we just couldn’t see it.”
Jason S. Slakter
Citing updated results from the CATT, Slakter said that 20% of patients in the trial developed geographic atrophy within 2 years of treatment initiation. Risk factors included poor visual acuity, presence of retinal angiomatous proliferation lesion, foveal intraretinal fluid, monthly dosing of anti-VEGF therapy, and treatment with Lucentis (ranibizumab, Genentech) but not Avastin (bevacizumab, Genentech).
“Do we believe that geographic atrophy developed as a result of anti-VEGF therapy?” Slakter asked. “I would say, ‘Not so fast.’”
Slakter further cited results from a retrospective analysis led by K. Bailey Freund, MD, at Vitreous-Retina-Macula Consultants of New York in which 91 consecutive patients receiving anti-VEGF therapy were followed for at least 12 months on a treat-and-extend regimen of ranibizumab. In that analysis, 55% of patients showed some atrophic changes over time.
“In addition to presence of atrophy at baseline, lesion type played a huge role in development of geographic atrophy,” Slakter said. “The sub-RPE lesions, that is, the type 1 CNV lesions, had the lowest rate of developing GA compared to other types of neovascularization.”
Now that the CATT has brought forward the question of the role of geographic atrophy in AMD, many more questions remain unanswered.
“We need to address atrophy as part of our overall management of AMD,” Slakter said.
Disclosure: Slakter is a consultant for or has received grant research funds from Allergan, Genzyme, Lpath and Ohr.