Baseline Predictors for Good Versus Poor Visual Outcomes in the Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Therapy

Chae, Byung Kook; Jung, Jesse J.; Mrejen, Sarah; Gallego-Pinazo, Roberto; Yannuzzi, Nicolas A.; Patel, Samir N.; Chen, Christine Y.; Marsiglia, Marcela; Boddu, Sucharita; Freund, K. Bailey

doi:10.1167/iovs.15-16494

Cited by 51 publications

(28 citation statements)

References 36 publications

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“…One study found that type 1 CNV was associated with better long‐term vision compared to types 2 and 3 (Chae et al. ).…”

Section: Resultsmentioning

confidence: 99%

“…With regard to the vitreomacular interface, it was found that the presence of VMA was associated with relatively poor visual outcomes, with patients having a complete PVD showing higher visual gains (Nomura et al 2014;Uney et al 2014). One study found that type 1 CNV was associated with better long-term vision compared to types 2 and 3 (Chae et al 2015).…”

Section: Prognostic Indicators From Retrospective Trialsmentioning

confidence: 99%

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Age‐related macular degeneration: using morphological predictors to modify current treatment protocols

Ashraf

Souka

Adelman³

2017

Acta Ophthalmologica

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To assess predictors of treatment response in neovascular age-related macular degeneration (AMD) in an attempt to develop a patient-centric treatment algorithm. We conducted a systematic search using PubMed, EMBASE and Web of Science for prognostic indicators/predictive factors with the key words: 'age related macular degeneration', 'neovascular AMD', 'choroidal neovascular membrane (CNV)', 'anti-vascular endothelial growth factor (anti-VEGF)', 'aflibercept', 'ranibizumab', 'bevacizumab', 'randomized clinical trials', 'post-hoc', 'prognostic', 'predictive', 'response' 'injection frequency, 'treat and extend (TAE), 'pro re nata (PRN)', 'bi-monthly' and 'quarterly'. We only included studies that had an adequate period of follow-up (>1 year), a single predefined treatment regimen with a predetermined re-injection criteria, an adequate number of patients, specific morphological [optical coherence tomography (OCT)] criteria that predicted final visual outcomes and injection frequency and did not include switching from one drug to the other. We were able to identify seven prospective studies and 16 retrospective studies meeting our inclusion criteria. There are several morphological and demographic prognostic indicators that can predict response to therapy in wet AMD. Smaller CNV size, subretinal fluid (SRF), retinal angiomatous proliferation (RAP) and response to therapy at 12 weeks (visual, angiographic or OCT) can all predict good visual outcomes in patients receiving anti-VEGF therapy. Patients with larger CNV, older age, pigment epithelial detachment (PED), intraretinal cysts (IRC) and vitreomacular adhesion (VMA) achieved less visual gains. Patients having VMA/VMT required more intensive treatment with increased treatment frequency. Patients with both posterior vitreous detachment (PVD) and SRF require infrequent injections. Patients with PED are prone to recurrences of fluid activity with a reduction in visual acuity (VA). A regimen that involves less intensive therapy and extended follow-up intervals (4 weekly) can be suggested for patients who show adequate visual response and have both SRF and PVD at baseline. In addition, patients with poor prognostic indicators such as IRC, VMA, large CNV size, older age and poor response at 12 weeks should be extended very cautiously with the possibility of fixed monthly/bimonthly (every 2 months) treatments if they fail to achieve dryness. Patients with PED at baseline should receive monthly/bimonthly injections of anti-VEGF therapy or can be extended very cautiously (two weekly intervals) using a TAE protocol.

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“…One study found that type 1 CNV was associated with better long‐term vision compared to types 2 and 3 (Chae et al. ).…”

Section: Resultsmentioning

confidence: 99%

Section: Prognostic Indicators From Retrospective Trialsmentioning

confidence: 99%

Age‐related macular degeneration: using morphological predictors to modify current treatment protocols

Ashraf

Souka

Adelman³

2017

Acta Ophthalmologica

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“…Analyses of trial data suggested that continuous monthly treatment (vs pro re nata ) was associated with a higher risk of incident atrophy and faster atrophy progression over 1–2 years 5–8 . This effect varies with the neovascularization subtype 8–12 and may depend on the specific anti-VEGF agent used 8 . In contrast, when followed 5 years or more, vision loss may progress more slowly in eyes receiving a continuous vs pro re nata anti-VEGF regimen 2 .…”

Section: Introductionmentioning

confidence: 99%

Visualizing Retinal Pigment Epithelium Phenotypes in the Transition to Atrophy in Neovascular Age-Related Macular Degeneration

Zanzottera

Ach

Huisingh

et al. 2016

Retina

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Purpose To enable future studies of retinal pigment epithelium (RPE) fate in the macular atrophy occurring in eyes with neovascular AMD (nvAMD), we determined how RPE morphology changes across the transition from health to atrophy in donor eyes with nvAMD. Method In RPE-Bruch’s membrane flat mounts of 5 nvAMD eyes the terminations of organized RPE cytoskeleton and autofluorescent material were compared. In high-resolution histological sections of 27 nvAMD eyes, RPE phenotypes were assessed at ±500 and ±100 µm from the descent of the external limiting membrane (ELM) towards Bruch’s membrane. Thicknesses of RPE, basal laminar deposit (BLamD), and RPE+BLamD were determined. Shapes of the ELM descent were recorded. Results Approaching the ELM descent, the percentage of different RPE phenotypes (Zanzottera, IOVS 2015) and the thickness of RPE, BLamD, and RPE + BLamD each stayed roughly constant. When compared to a separately described cohort of eyes with geographic atrophy, eyes with nvAMD were more likely to have RPE dysmorphia that did not worsen towards the atrophy border, thinner BLamD overall (3.25 ± 3.46 µm vs 7.99 ± 7.49 µm for geographic atrophy), and a higher proportion of oblique ELM descents (47.9% vs 31.9%). Conclusion The distribution of RPE phenotypes at the transition to macular atrophy in eyes with nvAMD differs from that in primary geographic atrophy, likely reflecting greater photoreceptor loss and the effects of exudation in nvAMD. This distribution, the shape of ELM descents, and thickness profiles may be useful metrics in clinical studies of macular atrophy utilizing optical coherence tomography and fundus autofluorescence.

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“…Current methods used to identify "good" and "poor" responders include stratifying disease status by markers of structure or function using tools such as optical coherence tomography (OCT) 6 , fluorescein angiography for lesion type 7 , and visual acuity tests 8 . Some imaging biomarkers such as the presence of intra retina fluid [9][10][11] and clinical signs such as poor starting vision 12,13 are associated with long-term poor prognosis, but these biomarkers do not precisely predict response to anti-VEGF treatment.…”

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confidence: 99%

A serum metabolomics study of patients with nAMD in response to anti-VEGF therapy

Gao

Teo

Beuerman

et al. 2020

Sci Rep

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intravitreal injection of anti-vascular endothelial growth factor (anti-VeGf) is the current standard of treatment for choroidal neovascularization (cnV) secondary to neovascular age-related macular degeneration (nAMD), but there are no diagnostic tools to predict response of these therapies. We hypothesize that differences in baseline metabolic profiles of patients with nAMD may influence responsiveness to anti-VeGf therapy, and thus provide prognosticating information for these patients. A prospective study was performed on 100 patients with nAMD treated with anti-VEGF therapy. We classified patients into two groups: responders (n = 54) and non-responders (n = 46). The expression levels of glycerophosphocholine,LysoPC (18:2) and PS (18:0/20:4) were higher in non-responders and these findings were verified in the validation cohort, implicating that reductions in these three metabolites can be used as predictors for responsiveness to anti-VeGf therapy during the initial loading phase for patients with nAMD. our study also provided new insights into the pathophysiological changes and molecular mechanism of anti-VeGf therapy for nAMD patients.

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Baseline Predictors for Good Versus Poor Visual Outcomes in the Treatment of Neovascular Age-Related Macular Degeneration With Intravitreal Anti-VEGF Therapy

Cited by 51 publications

References 36 publications

Age‐related macular degeneration: using morphological predictors to modify current treatment protocols

Age‐related macular degeneration: using morphological predictors to modify current treatment protocols

Visualizing Retinal Pigment Epithelium Phenotypes in the Transition to Atrophy in Neovascular Age-Related Macular Degeneration

A serum metabolomics study of patients with nAMD in response to anti-VEGF therapy

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