Elsevier

Ophthalmology

Volume 123, Issue 4, April 2016, Pages 865-875
Ophthalmology

Original article
Macular Morphology and Visual Acuity in the Second Year of the Comparison of Age-Related Macular Degeneration Treatments Trials

Presented in part at the Association for Research in Vision and Ophthalmology Meeting, May 4–8, 2014, Orlando, Florida.
https://doi.org/10.1016/j.ophtha.2015.12.002Get rights and content

Purpose

To describe the association between morphologic features on fundus photography (FP), fluorescein angiography (FA), and optical coherence tomography (OCT) and visual acuity (VA) in the second year of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).

Participants

Participants in the CATT.

Methods

Study eye eligibility required angiographic and OCT evidence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and VA between 20/25 and 20/320. Treatment was assigned randomly to ranibizumab or bevacizumab with 3 different dosing regimens over a 2-year period.

Main Outcome Measures

Fluid type, location, and thickness; retina and subretinal tissue complex thickness on OCT; size and lesion composition on FP and FA; and VA.

Results

Among 1185 CATT participants, 993 (84%) had fluid on OCT at baseline and completed 2 years of follow-up. At 2 years, intraretinal fluid (IRF), subretinal fluid (SRF), sub–retinal pigment epithelium (RPE) fluid, and subretinal tissue complex thickness decreased in all treatment groups. Ranibizumab monthly was best able to resolve each type of fluid. Eyes with SRF in the foveal center on OCT had better mean VA than eyes with no SRF (72.8 vs. 66.6 letters; P = 0.006). Eyes with IRF in the foveal center had worse mean VA than eyes without IRF (59.9 vs. 70.9 letters; P < 0.0001). Eyes with retinal thickness <120 μm had worse VA compared with eyes with retinal thickness 120 to 212 and >212 μm (59.4 vs. 71.3 vs. 70.3 letters; P < 0.0001). At 2 years, the mean VA (letters) of eyes varied substantially by the type of subfoveal pathology on FP and FA: 70.6 for no pathology; 74.1 for fluid only; 73.3 for CNV or pigment epithelial (RPE) detachment; 68.4 for nongeographic atrophy; and 62.9 for geographic atrophy, hemorrhage, RPE tear, or scar (P < 0.0001).

Conclusions

The associations between VA and morphologic features identified through year 1 were maintained or strengthened during year 2. Eyes with foveal IRF, abnormally thin retina, greater thickness of the subretinal tissue complex on OCT, and subfoveal geographic atrophy or scar on FP/FA had the worst VA. Subretinal fluid was associated with better VA.

Section snippets

Study Population

Details of the design and methods for CATT have been published.1, 2, 3 A total of 1185 subjects were enrolled by 43 clinical centers in the United States between February 2008 and December 2009. Only 1 eye per subject, the study eye, was treated as a part of the clinical trial. Inclusion criteria included age ≥50 years, presence of previously untreated active CNV secondary to age-related macular degeneration (AMD) in the study eye, and VA between 20/25 and 20/320. Choroidal neovascularization

Optical Coherence Tomography Morphologic Characteristics Over Time by Treatment Group

After anti-VEGF therapy, in all treatment groups there was a similar proportion of eyes with fluid of any type (IRF, SRF, or sub-RPE) from week 52 to week 104, except for the ranibizumab switched group, which showed an increase in the relative proportion of participants with fluid of any type (Fig 1A). The majority of this increase in the proportion of participants with fluid of any type in the ranibizumab switched group occurred between weeks 52 and 76. There was relatively little change

Discussion

During year 2 of this study, the week 52 associations of morphologic features determined on OCT, FA, and FP and VA were maintained or strengthened at week 104. In contrast to the large decreases in year 1 of the study, anti-VEGF treatment did not further reduce macular fluid, thickness, or vascular leakage, or stabilize lesion growth. Despite a lack of additional year 2 improvement in morphologic features, anti-VEGF therapy maintained or improved the VA gains achieved in year 1 of the study for

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Supplemental material is available at www.aaojournal.org.

Financial Disclosure(s): The author(s) have made the following disclosure(s): C.A.T.: Grants − Duke from the National Eye Institute, during the conduct of the study; Grants − Genentech, Bioptigen; Personal fees − Thrombogenics, outside the submitted work; Patent − OCT technology and software (pending).

M.G.M.: Personal fees − Genentech.

G.-S.Y.: Personal fees − Janssen R & D.

G.J.J.: Personal fees − Heidelberg Engineering, Neurotech, Alcon/Novartis, Genentech/Roche.

Supported by cooperative agreements U10 EY017823, U10 EY017825, U10 EY017826, U10 EY017828, and R21EY023689 from the National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland. The funding organization participated in the design and conduct of the study and review of the manuscript. ClinicalTrials.gov identifier NCT00593450.

Author Contributions:

Conception and design: Sharma, Toth, Daniel, Grunwald, Maguire, Ying, Huang, Martin, Jaffe

Data collection: Sharma, Toth, Daniel, Grunwald, Maguire, Ying, Huang, Martin, Jaffe

Analysis and interpretation: Sharma, Toth, Daniel, Grunwald, Maguire, Ying, Huang, Martin, Jaffe

Obtained funding: Not applicable

Overall responsibility: Sharma, Toth, Daniel, Grunwald, Maguire, Ying, Huang, Martin, Jaffe

A list of group members for the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group appears in the Appendix (available at www.aaojournal.org).

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