Baseline Predictors for One-Year Visual Outcomes with Ranibizumab or Bevacizumab for Neovascular Age-related Macular Degeneration

Abstract

Objective To determine baseline predictors of visual acuity (VA) outcomes at 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). Design Cohort study within the Comparison of AMD Treatments Trials. Participants 1105 participants with neovascular AMD, baseline VA 20/25 to 20/320, and VA measured at 1 year. Methods Participants were randomly assigned to ranibizumab or bevacizumab on either a monthly or as-needed schedule. Masked readers evaluated fundus morphology, and features on optical coherence tomography (OCT). VA was measured using electronic visual acuity testing. Independent predictors were identified using regression techniques. Main Outcome Measures VA score, VA score change from baseline, and ≥3-line gain at 1 year. Results At one year, the mean VA score was 68 letters, mean improvement from baseline was 7 letters, and 28% of participants gained ≥3-line. Older age, larger area of choroidal neovascularization (CNV), and elevation of retinal pigment epithelium (RPE) were associated with worse VA (all p<0.005), less gain in VA (all p<0.02) and a lower proportion gaining ≥3-lines (all p<0.04). Better baseline VA was associated with better VA at 1 year, less gain in VA, and a lower proportion gaining ≥3-lines (all p<0.0001). Predominantly or minimally classic lesions were associated with worse VA than occult lesions (66 vs. 69 letters, p=0.0003). Retinal Angiomatous Proliferans (RAP) lesions were associated with more gain in VA (10 vs. 7 letters, p=0.03) and a higher proportion gaining ≥3-lines (odds ratio=1.9, 95% confidence interval: 1.2 – 3.1). Geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters, p=0.02). Eyes with total foveal thickness in the 2nd quartile (325 – 425 microns) had the best visual acuity (p=0.01) and were most likely to gain ≥3 lines (p=0.004). Predictors did not vary by treatment group. Conclusion For all treatment groups, older age, better baseline VA, larger CNV area, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, greater total fovea thickness and RPE elevation on OCT were independently associated with less improvement in VA at 1 year.

Defining response to anti-VEGF therapies in neovascular AMD

“…11,12 Hypersensitivity to an anti-VEGF or similar product should merit discontinuation of therapy and switch to another product. 7 It has been reported that predictors for poor response at 12 months include: older age, better baseline acuity, larger CNV size, angiographic lesion type, the absence of RAP and the presence of GA, in addition to higher foveal thickness, PED or elevation on OCT. 21 This confirms the earlier reports from Kaiser et al 71 that baseline vision, CNV size and age were important predictors of treatment outcomes with ranibizumab. Higher gain in acuity is often a function of poor starting vision and reflects a ceiling effect of BCVA measurements in n-AMD.…”

“…The degree of change in VA is contingent on the baseline acuity, that is, at the time-point at which treatment is initiated. 16,[19][20][21] It is intuitive to suppose that treatment given when the disease has not caused permanent destruction of the neural and supporting cells will result in best outcomes. Morphological changes precede the loss of visual function.…”

Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis

“…3,4 To date, the Amsler grid and preferential hyperacuity perimetry (PHP) are two frequently used tests in the diagnostic work-up in clinical practice. 5,6 Besides them, several additional modifications and new tests, such as the shape discrimination hyperacuity test, 7,8 have been proposed, but their diagnostic value has not yet been systematically studied.…”

Blood flow velocity measured using the Retinal Function Imager predicts successful ranibizumab treatment in neovascular age-related macular degeneration: early prospective cohort study

“…Although the levels of pretreatment visual acuity and several morphologic parameters in OCT have been assessed in detail as possible predictors for treatment outcome, 23 the role of factors of retinal hemodynamics indicating at a treatment response are ill understood. We are aware of only one study by Barak et al 17 that looked into the short-term effects of bevacizumab (Avastin) on RBFV.…”