This study investigates the relationship between ellipsoid zone (EZ) integrity and visual acuity (VA) in patients with dry age-related macular degeneration (AMD) over a 5-year follow-up period. Using spectral domain optical coherence tomography (SD-OCT) and machine learning-enabled feature extraction, quantitative EZ parameters were derived from SD-OCT images. The results show significant correlations between EZ integrity metrics and VA. Eyes with excellent VA (≥20/25 Snellen) exhibited higher EZ integrity, including less EZ attenuation, thicker EZ-retinal pigment epithelium (EZ-RPE) thickness, and higher EZ intensity, compared to eyes with worse VA (≤20/40 Snellen). Eyes with geographic atrophy (GA) in the foveal region also showed compromised EZ integrity. Baseline EZ integrity metrics were predictive of future VA loss, suggesting that quantitative SD-OCT measurements of EZ integrity could serve as valuable indicators for predicting functional outcomes in dry AMD. These findings highlight the importance of EZ integrity assessment in understanding and managing dry AMD.This study investigates the relationship between ellipsoid zone (EZ) integrity and visual acuity (VA) in patients with dry age-related macular degeneration (AMD) over a 5-year follow-up period. Using spectral domain optical coherence tomography (SD-OCT) and machine learning-enabled feature extraction, quantitative EZ parameters were derived from SD-OCT images. The results show significant correlations between EZ integrity metrics and VA. Eyes with excellent VA (≥20/25 Snellen) exhibited higher EZ integrity, including less EZ attenuation, thicker EZ-retinal pigment epithelium (EZ-RPE) thickness, and higher EZ intensity, compared to eyes with worse VA (≤20/40 Snellen). Eyes with geographic atrophy (GA) in the foveal region also showed compromised EZ integrity. Baseline EZ integrity metrics were predictive of future VA loss, suggesting that quantitative SD-OCT measurements of EZ integrity could serve as valuable indicators for predicting functional outcomes in dry AMD. These findings highlight the importance of EZ integrity assessment in understanding and managing dry AMD.