Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use

Figures & data

Figure 1 Flow diagram showing the study population enrolled in a cross-sectional study across 17 sites in the United Kingdom, Germany, Ireland, and Canada.

Notes: ^aReasons for exclusion from analysis, GA group: non-bilateral physician-confirmed GA; age ≤70 years at study inclusion; no informed consent; history of CNV, DME, and/or RVO; protocol deviation. ^bReasons for exclusion from analysis, non-GA group: ophthalmic condition affecting visual function; no informed consent; history of CNV, DME, and/or RVO. ^cA site in Ireland leveraged electronic medical records to actively recall patients slightly earlier than their scheduled visit during the initial recruitment phase. Inclusion of these patients would have affected health care resource utilization results, so the protocol had to be clarified mid study, and a decision was made to exclude these patients from the analysis due to protocol deviation following this protocol change. Subsequent patients that were contributed by this site were recruited according to updated protocols (recruitment only during routine visits).

Abbreviations: CNV, choroidal neovascularization; DME, diabetic macular edema; GA, geographic atrophy; RVO, retinal vein occlusion.

Table 1 Sociodemographic Characteristics of the GA and Non-GA Groups in a Cross-Sectional Study Conducted in 17 Sites in the United Kingdom, Germany, Ireland, and Canada

Variable	GA Group (n=137)	Non-GA Group (n=52)	Total (N=189)	P-Value^a
Age at study inclusion (y), mean (SD) [95% CI]	81.8 (6.5) [80.7–82.9]	78.3 (6.0) [76.7–79.9]	80.8 (6.5) [79.9–81.7]	<0.001^b
Female, n (%)	90 (65.7)	31 (59.6)	121 (64.0)	0.439^c
Race, n (%)
Caucasian	134 (97.8)	51 (98.1)	185 (97.9)	0.727^d
Asian	1 (0.7)	1 (1.9)	2 (1.1)
Other	2 (1.5)	0	2 (1.1)
Marital status, n (%)
Single/never married	8 (5.8)	5 (9.6)	13 (6.9)	0.024^d
Married/domestic partnership	60 (43.8)	33 (63.5)	93 (49.2)
Divorced	12 (8.8)	1 (1.9)	13 (6.9)
Widowed	57 (41.6)	13 (25.0)	70 (37.0)
Separated	0	0	0
Living status, n (%)
Home alone	64 (46.7)	13 (25.0)	77 (40.7)	0.024^d
Home with family or friends	64 (46.7)	36 (69.2)	100 (52.9)
Assisted living facility	7 (5.1)	3 (5.8)	10 (5.3)	0.183^d
Private^e	6 (85.7)	1 (33.3)	7 (70.0)
Public^e	1 (14.3)	2 (66.7)	3 (30.0)
Nursing/residential care home	2 (1.5)	0	2 (1.1)	NA
Private^f	1 (50.0)	0	1 (50.0)
Public^f	1 (50.0)	0	1 (50.0)
No. living at home, including patient
n (%)	128 (93.4)	49 (94.2)	177 (93.7)	0.474^b
Mean (SD)	1.7 (0.9)	1.8 (0.5)	1.7 (0.8)
Highest level of education, n (%)
None of the below	14 (10.3)	2 (3.8)	16 (8.5)	0.229^d
Lower secondary	69 (50.7)	25 (48.1)	94 (50.0)
Upper secondary	28 (20.6)	9 (17.3)	37 (19.7)
Some university/college	9 (6.6)	4 (7.7)	13 (6.9)
University/college degree	7 (5.1)	8 (15.4)	15 (8.0)
Graduate degree	9 (6.6)	4 (7.7)	13 (6.9)
Missing	1	0	1
Insurance status, n (%)
Insured	85 (62.0)	32 (61.5)	117 (61.9)	0.949^c
Not insured	52 (38.0)	20 (38.5)	72 (38.1)
Smoking status, n (%)				0.050^c
Current smoker	9 (6.6)	0	9 (4.8)
Ex-smoker (quit ≥6 months prior)	54 (39.7)	22 (42.3)	76 (40.4)
Never smoked	73 (53.7)	30 (57.7)	103 (54.8)
Missing	1	0	1

Notes: ^aP≤0.05 is considered significant. ^bstudent’s t-test. ^cChi-square test. ^dFisher’s exact test. ^ePercentage based on the total number of patients living in an assisted living facility. ^fPercentage based on the total number of patients living in nursing/residential care home. Percentages, means, and medians are based on non-missing values.

Abbreviations: GA, geography atrophy; NA, not applicable.

Figure 2 Mean (95% CI) NEI-VFQ-25 scores for the GA and non-GA groups in a cross-sectional study conducted in 17 sites in the United Kingdom, Germany, Ireland, and Canada.^a

Notes: ^aComposite and subscale scores range from 0–100, with higher scores indicating better vision-related functioning. Additional subscales are provided in Table S5. *P<0.001 by Wilcoxon rank-sum test.

Abbreviations: GA, geographic atrophy; NEI-VFQ-25, National Eye Institute Visual Function Questionnaire-25.

Table 2 VA of the GA and Non-GA Groups in a Cross-Sectional Study Conducted in 17 Sites in the United Kingdom, Germany, Ireland, and Canada

Variable	GA Group		Non-GA Group
	Better-Seeing Eye (n=134)^a	Worse-Seeing Eye (n=134)^a	Better-Seeing Eye (n=50)^a	Worse-Seeing Eye (n=50)^a
VA (logMAR unit)	n=128	n=119	n=50	n=50
Mean (SD) [95% CI]	0.6 (0.4) [0.53–0.67]	1.0 (0.5) [0.91–1.09]	0.1 (0.1) [0.07–0.13]	0.2 (0.2) [0.14–0.26]
Approximate Snellen equivalent	~20/80	~20/200	~20/25	~20/32
VA category (logMAR unit group), n (%)	n=128	n=119	n=50	n=50
Range of normal vision (–0.30 to 0.10)	10 (7.8)	4 (3.4)	36 (72.0)	20 (40.0)
Near-normal vision (0.20–0.50)	57 (44.5)	21 (17.6)	14 (28.0)	29 (58.0)
Moderate-low vision (0.60–1.30)	58 (45.3)	67 (56.3)	0	1 (2.0)
Blind (1.40–2.00)	3 (2.3)	27 (22.7)	0	0
Mean (SD) time since VA measurement (d)	0.5 (2.2)	0.5 (2.2)	0.1 (0.6)	0.1 (0.6)
Best-corrected or uncorrected VA, n (%)
Best-corrected VA	70 (52.2)	69 (51.5)	19 (38.0)	20 (40.0)
VA without lenses	26 (19.4)	26 (19.4)	19 (38.0)	18 (36.0)
VA with lenses	38 (28.4)	39 (29.1)	12 (24.0)	12 (24.0)
Measurement type, n (%)
ETDRS (letter score)	26 (19.4)	25 (18.7)	8 (16.0)	8 (16.0)
Snellen (ft/m/decimal)	102 (76.1)	94 (70.1)	42 (84.0)	42 (84.0)
Low vision	6 (4.5)	15 (11.2)	0	0

Note: ^aThree patients in the GA group and 2 patients in the non-GA group had only one eye with a VA measurement and were therefore not included in this analysis because their better-/worse-seeing eye could not be determined. Note: percentages and means are based on non-missing values.

Abbreviations: ETDRS, Early Treatment Diabetic Retinopathy Study; GA, geographic atrophy; logMAR, logarithm of the minimum angle of resolution; VA, visual acuity.

Table 3 Vision-Specific Characteristics of the GA Group in a Cross-Sectional Study Conducted in 17 Sites in the United Kingdom, Germany, Ireland, and Canada

Variable	GA Group (n=137)
Registered as legally blind (self-report), n (%)
Yes	17 (12.4)
Ongoing^a	8 (5.8)
Driving license, n (%)
Yes	76 (55.5)
Confident driving during the day, n (%)^b	n=76
Yes	36 (48.0)
Confident driving at night, n (%)^b	n=76
Yes	9 (12.0)
Transport regularly used, n (%)^c
Do not use transport	1 (0.7)
Drive own vehicle	36 (26.3)
Public transport	66 (48.2)
Taxi	56 (40.9)
Travel with paid caregiver	8 (5.8)
Travel with partner/friend	103 (75.2)
Adjustment(s) made to home, n (%)^b
Yes	53 (39.0)
Participation in vision support group(s), n (%)
Yes	10 (7.3)
Support/benefit from government, n (%)^b
Yes	16 (11.8)
Used eye rehabilitation services in 12 months prior, n (%)^c,d	25 (18.2)
Low-vision clinics	22 (88.0)
Physical/occupational therapist	2 (8.0)
Support groups	3 (12.0)
Other	1 (4.0)
Used vision-related equipment in 12 months prior, n (%)^c,e	74 (54.0)
Portable lighting	18 (24.3)
Glasses	47 (63.5)
Magnifiers	56 (75.7)
Binoculars	5 (6.8)
Reading aids	13 (17.6)
Independent living aids	10 (13.5)
Computer and communication tools	1 (1.4)
Cane, white cane, walking stick	13 (17.6)
Other	7 (9.5)
Assistance with activities of daily living, n (%)
Yes received assistance:	60 (43.8)
Unpaid assistance^f	43 (71.7)
Paid assistance^f	17 (28.3)
No assistance required	77 (56.2)
Home health services in 12 months prior, n (%)^c,g	14 (10.2)
Community nurse/occupational therapist	9 (64.3)
Counseling	0
Support from charities	2 (14.3)
Other	5 (35.7)

Notes: ^aPatients were currently going through the process for blindness classification and/or registration process pending completion. ^bInformation missing for 1 patient. ^cPatients could contribute to multiple categories. ^dPercentages for each service were based on the total number of patients using an eye rehabilitation service during the specified period (0–12 months before index). ^ePercentages for each piece of equipment were based on the total number of patients using vision-related equipment during the specified period (0–12 months). ^fPercentages were based on the total number of patients who received assistance. ^gPercentages for each health care service were based on the total number of patients using health care services during the specified period (0–12 months before index). Percentages are based on non-missing values.

Abbreviation: GA, geographic atrophy.