Abstract
Importance: When initiating anti-VEGF treatment for neovascular age-related macular degeneration (nAMD), knowledge of prognostic factors is important for advising patients
and guiding treatment.
Objective: To investigate whether visual and anatomic outcomes in eyes with nAMD initiating anti-VEGF treatment are associated with fluctuations in retinal thickness. We hypothesized that eyes with greater fluctuation in retinal thickness over time have worse outcomes than eyes with less variation.
Design: Individual participant data meta-analysis.
Setting: Comparison of age-related macular degeneration treatment trials (CATT) and alternative treatments to inhibit VEGF in age-related choroidal neovascularization (IVAN) trial.
Participants: People with previously untreated nAMD.
Main outcomes and measures: We extracted foveal center point thickness (FCPT) for CATT (n=1165) and IVAN study eyes (n=566), excluding those with ≤3 measurements. For each
eye we calculated the standard deviation of FCPT (FCPTSD). Eyes were grouped by quartile of FCPTSD. Associations between FCPTSD quartile and outcomes were quantified at month 24 or last available visit by linear or logistic regression, adjusting for baseline BCVA and randomized allocations to drug and treatment regimen, for: best corrected visual acuity (BCVA) adjusted for baseline BCVA; development of fibrosis; development of macular atrophy.
Results: Data for 1731 IVAN and CATT participants were available. Median FCPTSD was 40.2 (interquartile range, IQR, 27.1, 61.2) in the IVAN cohort and 59.0 (IQR, 38.3, 89.4) in the CATT cohort. After adjustment for baseline BCVA and trial allocations, BCVA worsened significantly across the quartiles of FCPTSD; the difference between first and fourth quartiles
was 6.27 letters (95% CI 4.09-8.45). The risk of developing fibrosis and macular atrophy also increased across FCPTSD quartiles. Odds ratios for fibrosis ranged from 1.40 (95% CI 1.03-1.91) for Q2 to 1.95 (95% CI 1.42-2.68) for Q4, and for macular atrophy from 1.32 (95% CI 0.90-1.92) for Q2 to 2.10 (95% CI 1.45-3.05) for Q4.
Conclusions and relevance: Greater variation in retinal thickness in eyes with nAMD during treatment with anti-VEGF was associated with worse BCVA and development of fibrosis and
macular atrophy in these post-hoc analyses, despite protocol-directed treatment frequency. Practitioners may want to consider variation in retinal thickness when advising patients
about their prognosis.
and guiding treatment.
Objective: To investigate whether visual and anatomic outcomes in eyes with nAMD initiating anti-VEGF treatment are associated with fluctuations in retinal thickness. We hypothesized that eyes with greater fluctuation in retinal thickness over time have worse outcomes than eyes with less variation.
Design: Individual participant data meta-analysis.
Setting: Comparison of age-related macular degeneration treatment trials (CATT) and alternative treatments to inhibit VEGF in age-related choroidal neovascularization (IVAN) trial.
Participants: People with previously untreated nAMD.
Main outcomes and measures: We extracted foveal center point thickness (FCPT) for CATT (n=1165) and IVAN study eyes (n=566), excluding those with ≤3 measurements. For each
eye we calculated the standard deviation of FCPT (FCPTSD). Eyes were grouped by quartile of FCPTSD. Associations between FCPTSD quartile and outcomes were quantified at month 24 or last available visit by linear or logistic regression, adjusting for baseline BCVA and randomized allocations to drug and treatment regimen, for: best corrected visual acuity (BCVA) adjusted for baseline BCVA; development of fibrosis; development of macular atrophy.
Results: Data for 1731 IVAN and CATT participants were available. Median FCPTSD was 40.2 (interquartile range, IQR, 27.1, 61.2) in the IVAN cohort and 59.0 (IQR, 38.3, 89.4) in the CATT cohort. After adjustment for baseline BCVA and trial allocations, BCVA worsened significantly across the quartiles of FCPTSD; the difference between first and fourth quartiles
was 6.27 letters (95% CI 4.09-8.45). The risk of developing fibrosis and macular atrophy also increased across FCPTSD quartiles. Odds ratios for fibrosis ranged from 1.40 (95% CI 1.03-1.91) for Q2 to 1.95 (95% CI 1.42-2.68) for Q4, and for macular atrophy from 1.32 (95% CI 0.90-1.92) for Q2 to 2.10 (95% CI 1.45-3.05) for Q4.
Conclusions and relevance: Greater variation in retinal thickness in eyes with nAMD during treatment with anti-VEGF was associated with worse BCVA and development of fibrosis and
macular atrophy in these post-hoc analyses, despite protocol-directed treatment frequency. Practitioners may want to consider variation in retinal thickness when advising patients
about their prognosis.
| Original language | English |
|---|---|
| Number of pages | 9 |
| Journal | JAMA Ophthalmology |
| Volume | 138 |
| Issue number | 10 |
| Early online date | 20 Aug 2020 |
| DOIs | |
| Publication status | Published - 1 Oct 2020 |
Structured keywords
- BTC (Bristol Trials Centre)