Association between visual acuity, lesion activity markers and retreatment decisions in neovascular age-related macular degeneration

Chakravarthy, Usha; Pillai, Natasha; Syntosi, Annie; Barclay, Lorna; Best, Catherine; Sagkriotis, Alexandros

doi:10.1038/s41433-020-0799-y

Cited by 36 publications

(38 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, the visit numbers used to calculate the SD of fluctuations varied extensively across the population due to the real-world nature of this study. Another limitation of our study is the size of the patient sample which was moderate, nonetheless the observed demographics and clinical characteristics in this study were comparable to previous real-world nAMD studies [22,23].…”

Section: Discussionmentioning

confidence: 59%

Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD

Chakravarthy

Havilio

Syntosi

et al. 2021

Eye

Self Cite

View full text Add to dashboard Cite

Objectives To study the effect of repeated retinal thickness fluctuations during the anti-VEGF therapy maintenance phase in neovascular age-related macular degeneration (nAMD). Methods Data were extracted from electronic medical records of 381 nAMD patients, aged ≥50 years; baseline VA ≥33 and ≤73 letters; ≥24 months’ follow-up and ≥2 optical coherence tomography (OCT) measurements. OCT scans were analysed using an artificial intelligence algorithm that quantified the volumes of intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachments (PED) and central subfield thickness (CSFT). IRF, SRF and PED were summed to obtain total fluid (TF). The standard deviation (SD) of IRF, SRF, PED, CSFT and TF was computed and categorised into quartiles (SD-Q). Relationships between SD-Qs for each OCT feature and VA change was tested using generalised estimating equations and linear regression. Results By Month 24, compared to SD-Q1, eyes in SD-Q2, SD-Q3, and SD-Q4 for IRF, SRF, PED, CSFT and TF showed greater VA losses. Eyes in SD-Q4 of TF were 9.4 letters worse compared to eyes in Q1 (95% Confidence Interval: −12.9 to −6.0). The frequency of clinic visits with IRF and SRF present on OCT scans by quartiles of CSFT was lower in eyes with least fluctuation (Q1) compared to eyes with the most fluid fluctuation (Q4) (median [IQR] IRF: 0.3 [0.0–0.7] versus 0.8 [0.5–1.0]; SRF: 0.0 [0.0–0.5] versus 0.6 [0.3–1.0]). Conclusions Greater fluctuations in retinal fluid volumes during the maintenance phase of anti-VEGF treatment in nAMD is associated with worse VA by 2 years.

show abstract

Section: Discussionmentioning

confidence: 59%

Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD

Chakravarthy

Havilio

Syntosi

et al. 2021

Eye

Self Cite

View full text Add to dashboard Cite

show abstract

“…The HARBOR study highlighted that tolerating fluid can also lead to vision loss. A study by Chakravarthy et al [11] demonstrated that the absence of IRF or SRF at C 2 visits post-loading dose is associated with better VA outcomes at The ROG agreed that the evidence reviewed suggests better outcomes for patients if a dry macula is maintained. If patients lose disease control, then their vision may deteriorate to the extent that this vision loss cannot be recovered.…”

Section: Understanding the Impact Of Fluid In The Retina Of Namd Patientsmentioning

confidence: 99%

“…The HARBOR study highlighted that tolerating fluid can also lead to vision loss. A study by Chakravarthy et al [ 11 ] demonstrated that the absence of IRF or SRF at ≥ 2 visits post-loading dose is associated with better VA outcomes at 1 year compared to when IRF or SRF are absent at ≤ 1 visits.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical factors that impact the assessment of fluid and disease activity can include: poor image quality or segmentation; coexistant pathology, including epiretinal membrane, vitreomacular traction, atrophy, fibrosis, outer retinal tubulations, vitelliform lesions and other causes of fluid, including central serous retinopathy. There is also a poor correlation between vision and fluid and tendency to tolerate small amount of fluid in eyes with good vision [ 11 , 14 ]. OCT can be misinterpreted when there is presence of subretinal hyper-reflective material (SHRM), material that builds up between the retina and retinal pigment epithelia (RPE) [ 46 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, a clear definition of disease control is required, as there is not a general consensus at present. The view point that some fluid is beneficial in patients with nAMD also needs to be addressed [11][12][13][14]. It is important to note whilst there is preliminary evidence that patients with untreated subretinal fluid (SRF) can still manage a good outcome despite this disease activity [12,13], there is a misconception that leaving SRF untreated is in some way beneficial for the final outcome.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Importance of Anatomical Efficacy for Disease Control in Neovascular AMD: An Expert Opinion

et al. 2021

View full text Add to dashboard Cite

Background Neovascular age-related macular degeneration (nAMD) presents a significant treatment burden for patients, carers and medical retina services. However, significant debate remains regarding how best to manage nAMD when assessing disease activity by optical coherence tomography (OCT), and particularly the significance of different types of fluid and how the understanding of anatomical efficacy can influence treatment strategies. This article provides opinion on the practical implications of anatomical efficacy and significance of fluid in the management of nAMD and proposes recommendations for healthcare professionals (HCPs) to improve understanding and promote best practice to achieve disease control. Methods An evidence-based review was performed and an expert panel debate from the Retina Outcomes Group (ROG), a forum of retinal specialists, provided insights and recommendations on the definition, role and practical implications of anatomical efficacy and the significance of fluid at the macula in the management of nAMD. Results The ROG has developed recommendations for achieving disease control through a zero-tolerance approach to the presence of fluid in nAMD as patients who avoid fluctuations in fluid at the macula have better visual outcomes. Recommendations cover five key areas: service protocol, training, regimen, multidisciplinary teams and engagement. This approach facilitates more standardised protocol-based treatment strategies. Conclusions Targeting a fluid-free macula and aiming for disease control are essential to improve outcomes. As new therapies and technologies become available, drying the macula and maintaining disease control will become even more achievable. The outlined recommendations aim to promote best practice among HCPs and medical retina services to improve patient outcomes.

show abstract

Association Between Visual Acuity and Residual Retinal Fluid Following Intravitreal Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

et al. 2022

View full text Add to dashboard Cite

IMPORTANCEThe association between residual subretinal fluid (SRF) and intraretinal fluid (IRF) and visual acuity following anti-vascular endothelial growth factor (VEGF) treatment is not well understood.OBJECTIVE To examine the association of residual retinal fluid, SRF, and IRF with visual acuity following anti-VEGF treatment in patients with neovascular age-related macular degeneration (nAMD).DATA SOURCES A systematic literature search was performed from January 2005 to August 2021 using Ovid MEDLINE, Embase, and the Cochrane Library.STUDY SELECTION Peer-reviewed articles reporting on visual acuity stratified by the presence or absence of any residual SRF, IRF, or any retinal fluid at last study observation after intravitreal bevacizumab, ranibizumab, aflibercept, or brolucizumab in patients with nAMD were included. Studies that were noncomparative, included fewer than 10 eyes, or reported on other anti-VEGF agents were excluded.DATA EXTRACTION AND SYNTHESIS Two independent reviewers conducted data extraction and synthesis. The Cochrane risk of bias tool 2 and ROBINS-I were used to assess risk of bias and GRADE evaluation was conducted to assess certainty of evidence.MAIN OUTCOMES AND MEASURES Primary outcomes were BCVA at last study observation, change in BCVA from baseline, and retinal thickness at last study observation. RESULTSIn this systematic review and meta-analysis, 11 studies (6 randomized clinical trials [RCTs]) comprising 3092 eyes were included in our analysis. Across all included studies, the BCVA of eyes with residual SRF was better than eyes without SRF (weighted mean difference [WMD], 3.1 letter score; 95% CI, 0.05 to 6.18; P = .05; GRADE, low certainty of evidence; 6 studies; 1931 eyes) but similar in RCTs (WMD, 2.7 letter score; 95% CI, −2.40 to 7.84; P = .30; GRADE, low certainty of evidence; 3 studies; 1406 eyes). The BCVA of eyes with residual IRF was worse than that of eyes without IRF (WMD, −8.2 letter score; 95% CI, −11.79 to −4.50; P < .001; GRADE, low; 7 studies; 2114 eyes). CONCLUSIONS AND RELEVANCEThe findings suggest that the presence of residual SRF was associated with slightly better BCVA at last study observation; however, baseline differences in BCVA existed and this conclusion was primarily driven by 1 study. The presence of residual IRF was associated with substantially worse BCVA at last study observation and less improvement of BCVA from baseline. The conclusions are limited by the inclusion of data from observational studies, heterogeneity, and a low certainty of evidence.

show abstract

Association between visual acuity, lesion activity markers and retreatment decisions in neovascular age-related macular degeneration

Cited by 36 publications

References 30 publications

Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD

Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD

Importance of Anatomical Efficacy for Disease Control in Neovascular AMD: An Expert Opinion

Association Between Visual Acuity and Residual Retinal Fluid Following Intravitreal Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

Contact Info

Product

Resources

About