Predictors of Visual Acuity Outcomes after Anti–Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Central Retinal Vein Occlusion

Abstract

Purpose To evaluate whether baseline demographic, clinical, and OCT characteristics predict visual acuity (VA) outcomes in patients receiving anti–vascular endothelial growth factor (VEGF) therapy for macular edema (ME) due to central retinal vein occlusion (CRVO). Design Post hoc analysis of the randomized noninferiority trial (Lucentis, Eylea, Avastin in CRVO) LEAVO Study from December 12, 2014, to December 16, 2016, carried out across 44 UK National Health Service ophthalmology departments. Participants Data on 267 participants with a baseline best-corrected mean visual acuity (BCVA) range of 19 to 78 Early Treatment Diabetic Retinopathy Study letter score (approximate Snellen equivalent, 20/32 to 20/320) who had central subfield thickness (CST) ≥ 320 μm on Spectralis OCT (Heidelberg Engineering) were analyzed. Methods Study participants were randomized to receive repeated intravitreal injections of ranibizumab (0.5 mg/50 μl), aflibercept (2.0 mg/50 μl), or bevacizumab (1.25 mg/50 μl), and a protocol-driven pro re nata re-treatment regimen at 4 to 8 weekly visits was followed up to week 100 after 4 mandated 4-weekly loading injections. Main Outcome Measures Change in BCVA and percentage of patients gaining ≥ 10 letters and achieving BCVA letter score > 70 letters at 52 and 100 weeks. Results The analysis was adjusted for treatment effects and confirmed by sensitivity analysis. Age ≥ 75 years is a poor predictor for all 3 visual outcomes. Lower baseline BCVA predicted 10-letter gainers and higher gains in BCVA, although it is a poor predictor of achieving > 70 Early Treatment Diabetic Retinopathy Study letters. None of the baseline OCT morphologic characteristics except ellipsoid zone (EZ) integrity influenced any visual outcomes. Both baseline CST and total macular volume showed a nonlinear relation to 10-letter gainers, with CST > 900 μm being a poor prognostic indicator. Baseline CST and macular volume did not predict mean change in BCVA or BCVA > 70 letters at 52 and 100 weeks. The sensitivity analysis conclusions after removing iCRVO were similar. Conclusions At presentation, younger age, higher baseline BCVA, and a definitely intact subfoveal EZ are predictors of BCVA score > 70 letters at 100 weeks.

Background Factors Affecting Visual Acuity at Initial Visit in Eyes with Central Retinal Vein Occlusion: Multicenter Study in Japan

“…We also found that an older age was associated with poorer BCVA at the initial examination. This was not too surprising because there have been many past studies reporting that an older age was associated with poorer final visual outcomes in eyes with CRVO [ 16 , 18 , 19 , 20 ]. We assume that the age-related sclerotic changes in the arteries, and the degenerative changes of the vessel walls may be associated with this finding.…”

“…It is known that the baseline best-corrected visual acuity (BCVA) is the strongest predictor for the final BCVA in eyes with CRVO [ 16 , 17 , 18 , 19 , 20 ]. Therefore, the factors involved in visual acuity at the baseline can be indirectly related to the final visual outcome.…”

Background factors affecting visual acuity at initial visit in eyes with central retinal vein occlusion: multicenter study in Japan

“…This was not too surprising because there have been many past studies reporting that an older age was associated with worse nal visual outcomes in eyes with CRVO. 16,[18][19][20] We presume that the age-related sclerotic changes in the arteries and the degenerative changes of the vessel wall may be associated with this result. On the other hand, we cannot rule out the possibility that the age-related mild cataract might have affected our results because we excluded CRVO patients with only severe cataracts (≥grade 3) in this study.…”

“…[13][14][15] It is known that the baseline best-corrected visual acuity (BCVA) is the strongest predictor for the nal BCVA in eyes with CRVO. [16][17][18][19][20] However, a PubMed search did not extract any study examining the background factors of the patients that were signi cantly associated with poorer BCVAs at the initial visit to the hospital. Thus, the purpose of this study was to determine the baseline characteristics of patients with a CRVO that were signi cantly associated with the baseline BCVA.…”

The clinician’s guide to interpreting a regression analysis

“…Sen et al investigated the association between several factors (independent variables) and visual acuity outcomes (dependent variable) in patients receiving anti-vascular endothelial growth factor therapy for macular oedema (DMO) by means of both linear and logistic regression [9]. Multivariable linear regression demonstrated that age (Estimate −0.33, 95% CI − 0.48 to −0.19, p < 0.001) was significantly associated with best-corrected visual acuity (BCVA) at 100 weeks at alpha = 0.05 significance level [9]. The regression coefficient of −0.33 means that the BCVA at 100 weeks decreases by 0.33 with each additional year of older age.…”