On the relationship between visual acuity and central retinal (macular) thickness after interventions for macular oedema in diabetics: a review

Abstract

Purpose:The aim was to compare efficacy of treatments for diabetic macular oedema (DMO) from changes in visual acuity (VA) and central macular thickness (CMT). Methods: Peer-reviewed articles from 2004 to 2014 reporting intravitreal injections of bevacizumab (IVB), ranibizumab (IVR) or triamcinolone acetonide (IVTA) or laser photocoagulation therapy (LPT) provided data on pre-treatment (baseline) and final outcome measures. Net changes and relative changes (percentage) were assessed by linear regression analyses. Results: From 88 data sets the overall net change of VA was -0.10 ± 0.12 logMAR (mean ± stanndard deviation), being -0.13 ± 0.11 logMAR for IVB, 0 ± 0.08 logMAR for IVR and -0.12 ± 0.08 logMAR for IVTA as compared to 0.01 ± 0.14 logMAR for LPT. For CMT, the overall net change was -103 ± 71 microns, being -108 ± 64 microns for IVB, -182 ± 73 microns for IVR, and -102 ± 57 microns for IVTA and was -49 ± 60 microns for LPT. Overall, modest correlations were found between the absolute central retinal (macular) thickness change and the VA change, and the relative changes in these measures (p < 0.001, r = 0.522 or 0.457). The predicted visual outcome from a 100 microns reduction in CMT was -0.083 logMAR units, an effect not substantially influenced by the CMT measurement method. Conclusions: Pharmacological treatment of DMO can be expected to result in a predictable decrease in CMT with an accompanying increase in VA, with the overall outcome being better than laser treatment.

Real-Life Clinical Effectiveness of Razumab® (the World’s First Biosimilar of Ranibizumab) in Retinal Vein Occlusion: A Subgroup Analysis of the Pooled Retrospective RE-ENACT Study

“…Ganglion cell damage results from traction to the ganglion cell due to a greater CMT. A decrease in CMT with a concomitant increase in visual acuity is warranted by pharmacological treatment [34,35]. The current study demonstrated a significant decrease in CMT with ranibizumab biosimilar treatment, indicating improved disease outcomes and reflecting the results from the original pooled analysis.…”

Association Between Vessel Density and Visual Acuity in Patients With Diabetic Retinopathy and Poorly Controlled Type 1 Diabetes

“…Finally, the decrease in vessel density in the macula could be a result of the combined effects of PRP and the use of anti-VEGF therapy. However, the number of anti-VEGF injections was not different between the 2 groups of patients with diabetes, and numerous studies have shown that intravitreal injections of anti-VEGF did not cause a decreased vessel density or FAZ enlargement . We believe there is a low likelihood that these limitations could have affected the meaning of the role of the vessel density decrease in the DCC and especially in the role DCP plays in loss of VA.…”

Reduction in Retinal Thickness Fluctuations After Treatment With Fluocinolone Acetonide Implant for DME: A Post-Hoc Analysis of the USER Study

“…16,17 However, a reduction in retinal thickness is only modestly correlated with an improvement in VA, and it has been reported that there is a large variation in VA for any given retinal thickness. [16][17][18] Furthermore, gradual deterioration of VA in the absence of macular thickening can occur over time. 19 As demonstrated in refractory and regressed DME, mean OCT measured retinal thickness may not show a change over an extended period of follow-up; however, it may show significant variation from visit to visit.…”