Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

Abstract

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

Long-Term Control of Retinal Thickness Variability and Vision Following the 0.19 mg Fluocinolone Acetonide Implant

“…3 In analyses of RTV in anti-VEGF–treated eyes with age-related macular degeneration, high RTV was associated with poor VA outcomes at 2 years. 2,15 Similarly, anti-VEGF–treated eyes with DME demonstrated a direct correlation between RTV and visual outcomes at 12 months. 5…”

“…3 In analyses of RTV in anti-VEGF-treated eyes with age-related macular degeneration, high RTV was associated with poor VA outcomes at 2 years. 2,15 Similarly, anti-VEGF-treated eyes with DME demonstrated a direct correlation between RTV and visual outcomes at 12 months. 5 By contrast, previous reports on the 0.19 mg FAc implant reinforce its utility in controlling RTV and, therefore, patient outcomes.…”

“…1 Currently, the standard-of-care treatment for patients with DME is intravitreal (IVT) antivascular endothelial growth factor (anti-VEGF) therapy. 2 Although effective, short-term therapies such as anti-VEGF injections, which can require monthly administration, are associated with increased retinal thickness variability (RTV). These fluctuations are correlated with inconsistencies in the amount of disease control possible between injections and may be related to worse visual acuity (VA) outcomes over time.…”

“…2 Studies in patients receiving anti-VEGF therapy document significant retinal thickness fluctuations as measured by changes in central subfield thickness (CST) between treatments, 2 which then correlate with worse visual outcomes. [2][3][4][5] Use of a sustaineddelivery IVT corticosteroid implant may offer longer lasting and more consistent treatment effects when compared with anti-VEGF therapy. This more consistent drug delivery may reduce RTV and, therefore, result in better patient outcomes.…”

“…These fluctuations are correlated with inconsistencies in the amount of disease control possible between injections and may be related to worse visual acuity (VA) outcomes over time. 2 Studies in patients receiving anti-VEGF therapy document significant retinal thickness fluctuations as measured by changes in central subfield thickness (CST) between treatments, 2 which then correlate with worse visual outcomes. [2][3][4][5] Use of a sustaineddelivery IVT corticosteroid implant may offer longer lasting and more consistent treatment effects when compared with anti-VEGF therapy.…”