Ophthalmology, February 2019
In a cohort study of patients from the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT), Jaffe et al. looked at associations between macular morphology and visual acuity (VA) through five years of anti-VEGF treatment. They also sought to determine the retinal anatomic features that contributed to the VA results. They found the relationships between VA and morphology that had been identified in year 1 were sustained or strengthened by year 5. Strong contributors to VA decline from year 2 to year 5 included new foveal scar, choroidal neovascularization (CNV), retinal thinning, and the presence of intraretinal fluid (IRF) or subretinal hyper-reflective material (SHRM).
The study cohort included CATT participants with active CNV secondary to age-related macular degeneration and with a VA of 20/25 to 20/320. During CATT, patients were assigned randomly to receive ranibizumab or bevacizumab for two years; after this, treatment was at the discretion of each patient’s ophthalmologist. Outcomes of interest were VA, morphologic features on optical coherence tomography, and lesion size and foveal composition on fundus photography and fluorescein angiography.
Of the 914 participants alive at the five-year mark, image gradings and VA data were available for 523 (57%). At this time point, 66% of eyes had SHRM, 60% had IRF, 38% had subretinal fluid (SRF), and 36% had subretinal pigment epithelium (RPE) fluid. Mean foveal center thicknesses were 148 μm for the retina, 125 μm for the subretinal tissue complex, 103 μm for RPE + RPE elevation, 11 μm for SHRM, and 5 μm for SRF. Factors that were independently associated with poorer VA were SHRM (p < .001), thinner retina (p < .001), greater CNV lesion area (p < .001), foveal center pathology (p < .001), and IRF (p < .05). The adjusted mean number of VA letters was 65 for nongeographic atrophy; 64 for nonfibrotic scar; 62 for no pathology in the foveal center; 61 for CNV, fluid, or hemorrhage; 56 for fibrotic scar; and 53 for geographic atrophy (GA).
The presence or worsening of the following pathologic features in years 2 to 5 was linked to greater loss of VA from baseline to 5 years: GA area, foveal GA, foveal scar, foveal CNV, foveal IRF, SHRM, retinal thinning, and CNV lesion area. Such factors were present even in patients whose treatment remained aggressive.
The original article can be found here.