Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD
Top Cited Papers
Open Access
- 7 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Eye
- Vol. 35 (11), 2983-2990
- https://doi.org/10.1038/s41433-020-01354-4
Abstract
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.Keywords
Funding Information
- Novartis (N/A, N/A, N/A)
This publication has 21 references indexed in Scilit:
- IMPLICATION OF RECURRENT OR RETAINED FLUID ON OPTICAL COHERENCE TOMOGRAPHY FOR VISUAL ACUITY DURING ACTIVE TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION WITH A TREAT AND EXTEND PROTOCOLRetina, 2016
- Fluctuations in Pigment Epithelial Detachment and Retinal Fluid Using a Bimonthly Treatment Regimen with Aflibercept for Neovascular Age-Related Macular DegenerationOphthalmologica, 2015
- Guidelines for good pharmacoepidemiology practice (GPP)Pharmacoepidemiology and Drug Safety, 2015
- Optical Coherence Tomography Angiography Reveals Mature, Tangled Vascular Networks in Eyes With Neovascular Age-Related Macular Degeneration Showing Resistance to Geographic AtrophyOphthalmic Surgery, Lasers and Imaging Retina, 2015
- Clinical experience with fixed bimonthly aflibercept dosing in treatment-experienced patients with neovascular age-related macular degenerationClinical Ophthalmology, 2015
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaborationInternational Journal of Surgery, 2014
- World Medical Association Declaration of HelsinkiJAMA, 2013
- Administration of Repeat Intravitreal Anti-VEGF Drugs by Retina Specialists in an Injection-only Clinic for Patients with Exudative AMD: Patient Acceptance and SafetySeminars in Ophthalmology, 2011
- NOVEL METHOD FOR ANALYZING SNELLEN VISUAL ACUITY MEASUREMENTSRetina, 2010
- The Natural History and Prognosis of Neovascular Age-Related Macular Degeneration: A Systematic Review of the Literature and Meta-analysisOphthalmology, 2008