Macular thickness fluctuation in neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor

Chen, Eric R.; Chen, Andrew X.; Greenlee, Tyler; Conti, Thais F.; Briskin, Isaac; Urbano, Catherine A; Kalur, Aneesha; Kaiser, Peter K.; Singh, Rishi P.

doi:10.1016/j.jcjo.2021.06.004

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…In our study, a similar result was obtained that simple forms of CRT, including CRT baseline , CRT y1 , and CRT change , were not predictors of VA. In contrast, consistent with our observations, higher CRT variability was associated with worse VA in patients with nAMD receiving anti-VEGF treatment [16][17][18][19][20]. However, due to the main limitation of previous studies, i.e., the evaluation of variability using measurements from the entire course, these findings cannot be used for disease prediction.…”

Section: Discussionsupporting

confidence: 80%

“…Limited but growing evidence from longitudinal studies suggested a significant link between the variability of CRT and visual outcomes. For example, two retrospective cohorts [16,17] and three post hoc analyses of clinical trials [18][19][20] demonstrated that greater variation of CRT was associated with poorer VA. Although these findings were significant, they were hardly to be used for predicting because CRT measurements throughout the treatment process were used.…”

Section: Introductionmentioning

confidence: 99%

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The First-Year Variation in Central Retinal Thickness Predicts Legal Blindness in Patients with Neovascular Age-Related Macular Degeneration

Guo

Zheng

et al. 2022

Ophthalmic Res

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Background: Due to its progressive nature, early evaluation and timely prediction of legal blindness are important in patients with neovascular age-related macular degeneration (nAMD). We examined the association between early-stage variation in central retinal thickness (CRT) and long-term visual outcomes in patients with nAMD. Methods: We included 103 nAMD patients who were administered anti-vascular endothelial growth factor (anti-VGEF). Participants were considered qualified if they were: 1) 50 years and older, 2) treatment-naïve, 3) received standard anti-VEGF treatment and had complete baseline information. We further excluded patients with less than one-year follow-up data and those who experienced best-corrected visual acuity (BCVA) ≤35. Early-stage variability in CRT was measured as the first-year coefficient of variability (CV) of CRT. Patients were then classified into the high-variability and the low-variability groups according to the X-tile. A product-limit plot was used to demonstrate the differences and tested with the log-rank test. The association between first-year variability and visual outcomes was quantified using Cox regression models. Time-to-event primary endpoint was the overall visual preservation (OVP) rate, defined as the time from the first injection to legal blindness, i.e., BCVA ≤ 35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. Results: A threshold of 20% of first-year CV in CRT was used to categorized 76 qualified patients into high-variability (35, 46.1%) and low-variability (41, 53.9%). The 5- and 10-year OVPs for patients with high- vs. low-variability were 76% vs. 48%, and 59% vs. 22%, respectively. High early-stage CRT variability showed a significantly higher risk of legal blindness. Even after adjusting for the demographic and clinical features, the variability remained significant (HR=2.39, 95% CI: 1.20 to 4.78). Conclusions: First-year variability of CRT was predictive of long-term visual outcomes in patients with nAMD, and 20% of the variability could be used as a clinically convenient threshold to qualitatively classify patients into high- and low-variability groups. The current study is important for identifying high-risk populations and for long-term disease management.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

The First-Year Variation in Central Retinal Thickness Predicts Legal Blindness in Patients with Neovascular Age-Related Macular Degeneration

Guo

Zheng

et al. 2022

Ophthalmic Res

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“…Our results partly correspond with a previous observations reporting that every 100-µm increment in baseline CST was associated with an increase in CST SD by 24, which further translated to worsening 24-month visual outcomes. 10 Theoretically, accumulating fluid in subretinal space and neuroretinal compartments represents disease chronicity or more extensive involvement of MNV where physiological hemostasis of blood retinal barriers has been disrupted. 16 In case of insufficient treatment, such longstanding vascular leakage could outweigh rates of fluid absorption by the retinal pigment epithelium and accumulatively produces stagnant exudates above the external limiting membrane barrier and subretinal fibrosis; These may decelerate responses to anti-VEGF medications and subsequent fluctuating foveal thickness.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the CST values need to be controlled when assessing predictors of CST fluctuation. 10 , 12 In this study, a receiver operating characteristics (ROC) curve was performed to calculate the optimal cut-off point of baseline CST with the best sensitivity and specificity for detecting unstable CST after initial loading of anti-VEGF injections. To determine its odds ratio, this value was thereafter applied as one of the potential factors associated with high CST fluctuation in the first multivariate logistic regression model.…”

Section: Methodsmentioning

confidence: 99%

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Clinical Correlation of Retinal Fluid Fluctuation Represented by Fluctuation Index in Wet Age-Related Macular Degeneration: TOWER Study Report 2

Chantarasorn,

Ruamviboonsuk,

Thoongsuwan

et al. 2023

Trans. Vis. Sci. Tech.

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Purpose To explore outcomes and biomarkers associated with retinal fluid instability represented by a new parameter in neovascular age-related macular degeneration (nAMD). Methods Patients with treatment-naïve nAMD receiving anti-vascular endothelial growth factor (VEGF) injections for a duration of 1 to 3 years were consecutively reviewed. Fluctuation Index (FI) of each eye, calculated by averaging the sum of differences in 1-mm central subfield thickness between each follow-up from months 3 to 24, was arranged into ascending order from the lowest to the highest and split equally into low, moderate, and high fluctuation groups. Outcomes were analyzed at 24 months. Results Of 558 eyes, FI values showed a negative correlation with a degree–response gradient with 24-month visual improvement. After controlling for baseline best-corrected visual acuity and potential confounders, eyes with low fluctuation gained more Early Treatment Diabetic Retinopathy Study letters than those in the moderate and high fluctuation group (Δ, 10.1 and 14.0 letters, respectively). Significant best-corrected visual acuity improvement from baseline to month 24 (11.8 letters) was observed exclusively in the low fluctuation group despite the indifference in the number of injections and types of anti-VEGF drug used among groups. Patients presenting with central subfield thickness of ≥405 µm or intraretinal fluid coinciding with subretinal fluid showed a significant association with foveal thickness instability during the maintenance phase. Conclusions Apart from the central subfield thickness values, unstable macular thickening represented by the FI was associated with some baseline features and may contribute to substandard visual outcomes. Translational Relevance FI may be a valuable tool for assessing therapeutic adequacy in the treatment of nAMD.

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Phase I DAVIO Trial: EYP-1901 Bioerodible, Sustained-Delivery Vorolanib Insert in Patients With Wet Age-Related Macular Degeneration

Patel,

Storey,

Barakat

et al. 2024

Ophthalmology Science

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Macular thickness fluctuation in neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor

Cited by 4 publications

References 19 publications

The First-Year Variation in Central Retinal Thickness Predicts Legal Blindness in Patients with Neovascular Age-Related Macular Degeneration

The First-Year Variation in Central Retinal Thickness Predicts Legal Blindness in Patients with Neovascular Age-Related Macular Degeneration

Clinical Correlation of Retinal Fluid Fluctuation Represented by Fluctuation Index in Wet Age-Related Macular Degeneration: TOWER Study Report 2

Phase I DAVIO Trial: EYP-1901 Bioerodible, Sustained-Delivery Vorolanib Insert in Patients With Wet Age-Related Macular Degeneration

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