{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T18:09:13Z","timestamp":1778782153955,"version":"3.51.4"},"reference-count":51,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,4,8]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate associations between imaging biomarkers and quantitative contrast sensitivity (CS) function (qCSF) metrics in geographic atrophy (GA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cross-sectional study including 97 eyes from 70 patients (&gt;55 years) with GA within 1500\u2009\u00b5m of the fovea and visual acuity (VA)&gt;20\/320. Participants underwent VA and qCSF testing (area under the log CS function (AULCSF), contrast acuity (CA), and CS at 1\u201318 cycles per degree (cpd)) and multimodal imaging with blue autofluorescence (BAF), optical coherence tomography (OCT), and, in 55 eyes, swept-source OCT angiography (SS-OCTA). Imaging biomarkers included GA size, prior growth rate, configuration, BAF pattern, circularity, percentage of foveal involvement (%FI), foveal distance and macular inner choroid flow deficit percentage (mICFD%). Generalised linear mixed-effects and random forest (GRF) models evaluated structure\u2013function relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants (age 78.8\u00b15.6 years; 70% female) had a median GA size of 4.0\u2009mm\u00b2, with 64% showing subfoveal involvement. Larger GA size and higher %FI were significantly associated with worse VA, AULCSF, CA and CS at 1\u201312\u2009cpd (all p&lt;0.01). Unifocal lesions correlated with lower VA and CS at 6 cpd, while diffuse\/banded BAF patterns and greater mICFD% were linked to reduced CS at 1\u20131.5\u2009cpd. GRF analysis identified GA size and %FI as primary predictors of CS loss, with best performance for AULCSF and CS at 3 cpd (R\u00b2=0.319, 0.314).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GA size and %FI are key determinants of CS loss in GA. qCSF outperformed VA in predictive accuracy, supporting its use as a sensitive functional endpoint in GA trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-329036","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T17:20:21Z","timestamp":1778779221000},"page":"bjo-2025-329036","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal imaging determinants of contrast sensitivity loss in geographic atrophy"],"prefix":"10.1136","author":[{"given":"Francesco","family":"Romano","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Stettler","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Finn","sequence":"additional","affiliation":[{"name":"Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3778-5473","authenticated-orcid":false,"given":"Filippos","family":"Vingopoulos","sequence":"additional","affiliation":[{"name":"Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinyi","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Overbey","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas","family":"Cort","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8625-5367","authenticated-orcid":false,"given":"Chong","family":"Chen","sequence":"additional","affiliation":[{"name":"Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioanna","family":"Ploumi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Baldwin","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayla Nicole","family":"Nodecker","sequence":"additional","affiliation":[{"name":"Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selin S","family":"Gumustop","sequence":"additional","affiliation":[{"name":"Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivesh Himanshu","family":"Shah","sequence":"additional","affiliation":[{"name":"Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8136-4724","authenticated-orcid":false,"given":"In\u00eas","family":"La\u00edns","sequence":"additional","affiliation":[{"name":"Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"},{"name":"Universidade de Coimbra, Coimbra, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leo","family":"Kim","sequence":"additional","affiliation":[{"name":"Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demetrios","family":"Vavvas","sequence":"additional","affiliation":[{"name":"Retina, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deeba","family":"Husain","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2046-3996","authenticated-orcid":false,"given":"Joan W","family":"Miller","sequence":"additional","affiliation":[{"name":"Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0109-9738","authenticated-orcid":false,"given":"John B","family":"Miller","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2026051410201600000_bjo-2025-329036v1.1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.oret.2024.11.013","article-title":"Functional Outcomes and Quality of Life in Geographic Atrophy in the Clinical Setting","volume":"9","author":"Borkar","year":"2025","journal-title":"Ophthalmol Retina"},{"key":"2026051410201600000_bjo-2025-329036v1.2","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/eye.1988.106","article-title":"Evolution of geographic atrophy of the retinal pigment epithelium","volume":"2 (Pt 5)","author":"Sarks","year":"1988","journal-title":"Eye (Lond)"},{"key":"2026051410201600000_bjo-2025-329036v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.08.038"},{"key":"2026051410201600000_bjo-2025-329036v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.09.028"},{"key":"2026051410201600000_bjo-2025-329036v1.5","doi-asserted-by":"publisher","DOI":"10.1097\/IAE.0000000000001283"},{"key":"2026051410201600000_bjo-2025-329036v1.6","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1146\/annurev-vision-101922-045110","article-title":"Informing Endpoints for Clinical Trials of Geographic Atrophy","volume":"10","author":"Lad","year":"2024","journal-title":"Annu Rev Vis Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.7","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.17-22339"},{"key":"2026051410201600000_bjo-2025-329036v1.8","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.ophtha.2019.12.009","article-title":"Natural History of Geographic Atrophy Secondary to Age-Related Macular Degeneration: Results from the Prospective Proxima A and B Clinical Trials","volume":"127","author":"Holekamp","year":"2020","journal-title":"Ophthalmology"},{"key":"2026051410201600000_bjo-2025-329036v1.9","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.64.14.7","article-title":"Evaluating Contrast Sensitivity in Early and Intermediate Age-Related Macular Degeneration With the Quick Contrast Sensitivity Function","volume":"64","author":"Anders","year":"2023","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrs.2013.05.001"},{"key":"2026051410201600000_bjo-2025-329036v1.11","doi-asserted-by":"publisher","DOI":"10.1167\/10.2.17"},{"key":"2026051410201600000_bjo-2025-329036v1.12","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10132768","article-title":"Measuring the Contrast Sensitivity Function in Non-Neovascular and Neovascular Age-Related Macular Degeneration: The Quantitative Contrast Sensitivity Function Test","volume":"10","author":"Vingopoulos","year":"2021","journal-title":"J Clin Med"},{"key":"2026051410201600000_bjo-2025-329036v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2024.06.005"},{"key":"2026051410201600000_bjo-2025-329036v1.14","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00417-023-06291-y","article-title":"Test-retest repeatability and agreement of the quantitative contrast sensitivity function test: towards the validation of a new clinical endpoint","volume":"262","author":"Finn","year":"2024","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.15","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ajo.2024.11.006","article-title":"Associations Between Contrast Sensitivity, Optical Coherence Tomography Features and Progression From Intermediate to Late Age-related Macular Degeneration","volume":"271","author":"Bennett","year":"2025","journal-title":"Am J Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjo-2023-323507"},{"key":"2026051410201600000_bjo-2025-329036v1.17","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1993.01090060119035"},{"key":"2026051410201600000_bjo-2025-329036v1.18","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2004.057794"},{"key":"2026051410201600000_bjo-2025-329036v1.19","doi-asserted-by":"crossref","first-page":"101320","DOI":"10.1016\/j.preteyeres.2024.101320","article-title":"Extensive macular atrophy with pseudodrusen-like appearance (EMAP) clinical characteristics, diagnostic criteria, and insights from allied inherited retinal diseases and age-related macular degeneration","volume":"104","author":"Antropoli","year":"2025","journal-title":"Prog Retin Eye Res"},{"key":"2026051410201600000_bjo-2025-329036v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2020.100893"},{"key":"2026051410201600000_bjo-2025-329036v1.21","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1001\/jamaophthalmol.2013.572","article-title":"Square root transformation of geographic atrophy area measurements to eliminate dependence of growth rates on baseline lesion measurements: a reanalysis of age-related eye disease study report no. 26","volume":"131","author":"Feuer","year":"2013","journal-title":"JAMA Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.07.047"},{"key":"2026051410201600000_bjo-2025-329036v1.23","doi-asserted-by":"crossref","DOI":"10.1016\/j.xops.2021.100016","article-title":"Progression of Atrophy and Visual Outcomes in Extensive Macular Atrophy with Pseudodrusen-like Appearance","volume":"1","author":"Romano","year":"2021","journal-title":"Ophthalmol Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.24","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1177\/2474126419859454","article-title":"Percentage of Foveal vs Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degeneration","volume":"3","author":"Bagheri","year":"2019","journal-title":"J Vitreoretin Dis"},{"key":"2026051410201600000_bjo-2025-329036v1.25","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.62.13.28","article-title":"Local Progression Kinetics of Geographic Atrophy Depends Upon the Border Location","volume":"62","author":"Shen","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2018.05.005"},{"key":"2026051410201600000_bjo-2025-329036v1.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2021.11.004"},{"key":"2026051410201600000_bjo-2025-329036v1.28","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.10-6024"},{"key":"2026051410201600000_bjo-2025-329036v1.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2020.08.045"},{"key":"2026051410201600000_bjo-2025-329036v1.30","first-page":"2024","article-title":"Assessing the Repeatability of Inner Choroid Flow Deficit Percentage in Intermediate AMD and Controls: A Comparative Study between Different Post-processing Approaches","volume":"10","author":"Romano","year":"2024","journal-title":"Retina (Philadelphia, Pa)"},{"key":"2026051410201600000_bjo-2025-329036v1.31","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ajo.2025.05.021","article-title":"Updated Guidelines for Imaging the Choriocapillaris in Eyes with Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Angiography","volume":"278","author":"Berni","year":"2025","journal-title":"Am J Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.32","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1214\/18-AOS1709","article-title":"Generalized random forests","volume":"47","author":"Athey","year":"2019","journal-title":"Ann Statist"},{"key":"2026051410201600000_bjo-2025-329036v1.33","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(13)70145-1"},{"key":"2026051410201600000_bjo-2025-329036v1.34","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01583-0"},{"key":"2026051410201600000_bjo-2025-329036v1.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01520-9"},{"key":"2026051410201600000_bjo-2025-329036v1.36","doi-asserted-by":"crossref","DOI":"10.1016\/j.xops.2022.100173","article-title":"Longitudinal Evaluation of Visual Function Impairments in Early and Intermediate Age-Related Macular Degeneration Patients","volume":"2","author":"Lad","year":"2022","journal-title":"Ophthalmol Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.37","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.ajo.2024.03.023","article-title":"Association Between Quantitative and Qualitative Imaging Biomarkers and Geographic Atrophy Growth Rate","volume":"264","author":"de Carlo Forest","year":"2024","journal-title":"Am J Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.38","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(97)30079-7"},{"key":"2026051410201600000_bjo-2025-329036v1.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2020.01.019"},{"key":"2026051410201600000_bjo-2025-329036v1.40","doi-asserted-by":"crossref","DOI":"10.1016\/j.xops.2024.100519","article-title":"Visual Function Measurements in Eyes With Diabetic Retinopathy: An Expert Opinion on Available Measures","volume":"4","author":"Glassman","year":"2024","journal-title":"Ophthalmol Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.41","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1177\/0145482X0810201004","article-title":"Foveal-Sparing Scotomas in Advanced Dry Age-Related Macular Degeneration","volume":"102","author":"Sunness","year":"2008","journal-title":"J Vis Impair Blind"},{"key":"2026051410201600000_bjo-2025-329036v1.42","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.oret.2020.03.020","article-title":"Progression of Unifocal versus Multifocal Geographic Atrophy in Age-Related Macular Degeneration: A Systematic Review and Meta-analysis","volume":"4","author":"Shen","year":"2020","journal-title":"Ophthalmol Retina"},{"key":"2026051410201600000_bjo-2025-329036v1.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2015.10.029"},{"key":"2026051410201600000_bjo-2025-329036v1.44","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1001\/jamaophthalmol.2021.3826","article-title":"Association of Reading Performance in Geographic Atrophy Secondary to Age-Related Macular Degeneration With Visual Function and Structural Biomarkers","volume":"139","author":"K\u00fcnzel","year":"2021","journal-title":"JAMA Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.45","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.65.5.10","article-title":"Integrating Machine Learning and Traditional Survival Analysis to Identify Key Predictors of Foveal Involvement in Geographic Atrophy","volume":"65","author":"Cicinelli","year":"2024","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.46","first-page":"3278","article-title":"Aging of the human photoreceptor mosaic: evidence for selective vulnerability of rods in central retina","volume":"34","author":"Curcio","year":"1993","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.47","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1038\/eye.2001.140","article-title":"Photoreceptor topography in ageing and age-related maculopathy","volume":"15","author":"Curcio","year":"2001","journal-title":"Eye (Lond)"},{"key":"2026051410201600000_bjo-2025-329036v1.48","doi-asserted-by":"crossref","DOI":"10.1186\/s12886-020-01467-0","article-title":"Functionally validated imaging endpoints in the Alabama study on early age-related macular degeneration 2 (ALSTAR2): design and methods","volume":"20","author":"Curcio","year":"2020","journal-title":"BMC Ophthalmol"},{"key":"2026051410201600000_bjo-2025-329036v1.49","doi-asserted-by":"crossref","DOI":"10.1016\/j.xops.2023.100383","article-title":"Gradeability and Reproducibility of Geographic Atrophy Measurement in GATHER-1, a Phase II\/III Randomized Interventional Trial","volume":"4","author":"Li","year":"2024","journal-title":"Ophthalmol Sci"},{"key":"2026051410201600000_bjo-2025-329036v1.50","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.65.8.44"},{"key":"2026051410201600000_bjo-2025-329036v1.51","doi-asserted-by":"crossref","first-page":"101421","DOI":"10.1016\/j.preteyeres.2025.101421","article-title":"Functional endpoints in patients with geographic atrophy: What to consider when designing a clinical trial","volume":"110","author":"Dinah","year":"2026","journal-title":"Prog Retin Eye Res"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-329036","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T17:20:24Z","timestamp":1778779224000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-329036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":51,"alternative-id":["10.1136\/bjo-2025-329036"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-329036","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}