OCT Features That Predict Long-Term Visual Outcomes in nAMD

Patients with neovascular age-related macular degeneration (nAMD) face years of anti-VEGF injections, but their eventual outcomes are hard to predict. At the Retina Subspecialty Day on Saturday, SriniVas R. Sadda, MD, listed some telltale optical coherence tomography (OCT) features that predict long-term vision outcomes in these patients.

The findings stem from a retrospective study of 207 eyes that were treated with anti-VEGF therapy and followed for at least five years. Researchers grouped the patients by poor (<20/200), intermediate (20/40-20/200), or good (>20/40) final vision, and recorded the number of injections each patient received. On average, patients received five injections per year. Interestingly, those with best and the worst vision received the fewest injections.

After analyzing various OCT measures across the three groups, the researchers determined the top predictors of visual outcomes:

• Presence and thickness of the pigment epithelial detachment (PED) under the fovea.

• Outer retinal band/retinal pigment epithelium (RPE) disruption was associated with worse vision, whereas a thicker PED was associated with better vision.

• The most favorable morphology appears to have an absence of subretinal hyperreflective material and a thicker PED, with an intact overlying RPE.

If these findings hold up in future studies, they could help clinicians determine the ideal point in a patient’s progression to declare anti-VEGF treatment a success. —Anni Delfaro, PhD

Financial disclosures. Dr. Sadda: 4DMT: C; Allergan: C,S; Amgen: C; Bayer: C; Carl Zeiss Meditec: C,S; Centervue: C; Genentech: C; Heidelberg Engineering: C; Nidek: L; NightstarRx: C; Novartis Pharma AG: C; Optos: C; ThromboGenics: C; Topcon Medical Systems: L.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.

Read more news from AAO 2019 and the Subspecialty Day meetings.