Correlation of 3-Dimensionally Quantified Intraretinal and Subretinal Fluid With Visual Acuity in Neovascular Age-Related Macular Degeneration

Abstract

IMPORTANCE Robust and sensitive imaging biomarkers for visual function are an unmet medical need in the management of neovascular age-related macular degeneration. OBJECTIVE To determine the correlation of 3-dimensionally quantified intraretinal cystoid fluid (IRC) and subretinal fluid (SRF) with best-corrected visual acuity (BCVA) in treatment-naive neovascular age-related macular degeneration and during antiangiogenic therapy. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study between November 2009 and November 2011 at an institutional referral center and reading center of patients with treatment-naive subfoveal choroidal neovascularization receiving intravitreal ranibizumab or aflibercept over 12 months. All individual IRC and SRF lesions were manually delineated on each of the 128 B-scan sections of spectral-domain optical coherence tomographic volume scans at baseline and months 1, 6, and 12. Correlations were computed between the IRC and SRF parameters and the baseline BCVA, final BCVA, and BCVA change. A systematic parameter search was conducted to detect annotation-derived variables with best predictive value. An exponential model for BCVA change balancing for the ceiling effect was constructed. MAIN OUTCOMES AND MEASURES Goodness of fit of correlations between the IRC and SRF parameters and the baseline BCVA, final BCVA, and BCVA change. RESULTS Thirty-eight patients were included (25 female, 13 male; mean [SD] age at enrollment, 78.49 [8.23] years; mean [SD] BCVA score at baseline, 54 [16] Early Treatment Diabetic Retinopathy Study letters [Snellen equivalent approximately 20/160], with a gain to 63 [19] letters [Snellen equivalent approximately 20/100] at month 12). A total of 19 456 scans underwent complete quantification of IRC and SRF. The best correlation with BCVA at baseline was achieved using a coverage-based, foveal area-weighted IRC parameter (R 2 = 0.59; P < .001). The same baseline parameter also predicted BCVA at 12 months (R 2 = 0.21; P = .003). The BCVA gain correlated with IRC decrease in the exponential model (R 2 = 0.40; P < .001) and linear model (R 2 = 0.25; P = .002). No robust associations were found between SRF and baseline BCVA (R 2 = 0.06; P = .14) or BCVA change (R 2 = 0.14; P = .02). CONCLUSIONS AND RELEVANCE In this proof-of-principle study, IRC-derived morphometric variables correlated well with treatment-naive BCVA and BCVA outcomes in antiangiogenic therapy. While IRC reduction was associated with BCVA gains, some IRC-mediated neurosensory damage remained permanent.

Evaluating the impact of vitreomacular adhesion on anti-VEGF therapy for retinal vein occlusion using machine learning

“…After computing the voxel wise features as described above we trained a random forest classifier 38 on 337 B-scans of 88 macula-centred SD-OCT scans in which the posterior vitreous boundary was manually annotated by trained readers of the Vienna Reading Center as described previously 39 . Since only the exterior boundary of the vitreous cortex is of interest and was thus annotated we assumed the vitreous cortex region to be at least 3 voxels thick and excluded 20 voxels above the annotation from the training.…”

Characteristics and Predictors of Early and Delayed Responders to Ranibizumab Treatment in Neovascular Age-Related Macular Degeneration: A Retrospective Analysis from the ANCHOR, MARINA, HARBOR, and CATT Trials

“…In addition, real-world studies have also confirmed the strong correlation between baseline VA and VA outcomes as well as a possible link between baseline PED, the presence of blood, and/or retinal pigment epithelium (RPE) atrophy [19,[21][22][23][24][25][26]] to be predictive of response to treatment. Others have also shown increased subretinal tissue and the presence of subretinal fluid [27,28] or epiretinal membrane [29] to be predictive, but this has not been confirmed by some authors [25] . Our analysis indicates the subject's starting VA and the presence of PED and/or blood at baseline could potentially be used when assessing treatment response to determine if the subject is an early or delayed responder.…”

Comparative study between a spectral domain and a high-speed single-beam swept source OCTA system for identifying choroidal neovascularization in AMD

“…This difference may be of interest in the future, once CNV retreatment criteria will be based on OCTA. Considering the fast technical advances in this innovative field of research, high-resolution and depth-resolved OCTA volumes of neovascular lesions with integrated en-face information on the exudative status of the lesion1524 might soon become available and may replace invasive and time-consuming FA/ICGA25, which bares potential risks such as allergic shock26. This combination would allow early detection, as well as visualization and precise monitoring of the full CNV lesion in the course of the disease.…”