Comparing Accuracies of Length-Type Geographic Atrophy Growth Rate Metrics Using Atrophy-Front Growth Modeling

PURPOSE: To compare the accuracies of the previously proposed square-root-transformed and perimeter-adjusted metrics for estimating length-type geographic atrophy (GA) growth rates. DESIGN: Cross-sectional and simulation-based study. PARTICIPANTS: Thirty-eight eyes with GA from 27 patients. METHODS: We used a previously developed atrophy-front growth model to provide analytical and numerical evaluations of the square-root-transformed and perimeter-adjusted growth rate metrics on simulated and semisimulated GA growth data. MAIN OUTCOME MEASURES: Comparison of the accuracies of the square-root-transformed and perimeter-adjusted metrics on simulated and semisimulated GA growth data. RESULTS: Analytical and numerical evaluations showed that the accuracy of the perimeter-adjusted metric is affected minimally by baseline lesion area, focality, and circularity over a wide range of GA growth rates. Average absolute errors of the perimeter-adjusted metric were approximately 20 times lower than those of the square-root-transformed metrics, per evaluation on a semisimulated dataset with growth rate characteristics matching clinically observed data. CONCLUSIONS: Length-type growth rates have an intuitive, biophysical interpretation that is independent of lesion geometry, which supports their use in clinical trials of GA therapeutics. Taken in the context of prior studies, our analyses suggest that length-type GA growth rates should be measured using the perimeter-adjusted metric, rather than square-root-transformed metrics.