Abstract
Background: To analyze the sensitivity of best corrected visual acuity and microperimetry to detect significant visual changes after 3 intravitreal ranibizumab in exudative age-related macular degeneration. Design: Prospective, open-label study. Participants: 50 eyes of 50 naive patients affected by neovascular age-related macular degeneration were enrolled. Methods: Enrolled patients underwent to a loading phase of 3 monthly intravitreal injections of ranibizumab. Best-corrected visual acuity was investigated with the ETDRS chart at 4 m. Central retinal sensitivity was tested with microperimetry using a Goldmann III stimulus to 33 points over the 12° central of the macula with a 4-2 double staircase strategy. Main outcome measures: Comparison of changes in mean 4° central retinal sensitivity and best-corrected visual acuity in “BCVA relatively stable patients” (defined as change ≤ ± 4 ETDRS letters after treatment). Analysis of a possible relationship between changes in best-corrected visual acuity and 4° central retinal sensitivity in “mean 4° central retinal sensitivity relatively stable patients” (defined as change in mean retinal sensitivity ≤ ± 2dB) Results: Mean best-corrected visual acuity improved of 5.90 ± 11.29 ETDRS letters (P=0.0006). Total mean retinal sensitivity improved +1.59 ± 2.12 dB (P<0.0001), while in the 4° central retinal area the increase was +1.36 ± 3.45 dB (P=0.0078). 38% of patients (19 eyes) were considered as “BCVA relatively stable patients”. In this subgroup, Pearson’s correlation analysis showed a direct correlation between changes observed with both methods (r = 0.71; P = 0.002). 48% of patients (24 eyes) were considered as “Mean 4° central retinal sensitivity relatively stable patients”. In this subgroup, Pearson’s correlation analysis didn’t show a relationship between changes observed with both methods (r = 0.11; P = 0.56). Conclusions: Microperimetry central retinal sensitivity seems to be an important to complete the functional evaluation in patients with wet age-related macular degeneration after 3 intravitreal ranibizumab.
Highlights
Neovascular age-related macular degeneration is the leading cause of irreversible blindness in people ≥ 50 years old in the industrialized world [1].Recently, the most promising treatment of all forms of nAMD is represented by intravitreal anti-Vascular Endothelial Growth Factor drugs [2]
Microperimetry central retinal sensitivity seems to be an important to complete the functional evaluation in patients with wet age-related macular degeneration after 3 intravitreal ranibizumab
The most promising treatment of all forms of nAMD is represented by intravitreal anti-Vascular Endothelial Growth Factor drugs [2]
Summary
The most promising treatment of all forms of nAMD is represented by intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) drugs [2]. Two of the most important prospective, randomized, large-scale clinical trials on nAMD treatment with intravitreal anti-VEGF have demonstrated a statistically significant improvement in best-corrected visual acuity (BCVA) [3,4]. BCVA using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart has been considered the gold standard tool in order to assess the visual status in macular disorders and a primary end point to evaluate the functional outcome of new drugs in nAMD. To analyze the sensitivity of best corrected visual acuity and microperimetry to detect significant visual changes after 3 intravitreal ranibizumab in exudative age-related macular degeneration
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