Abstract
ObjectivesTo investigate the relationship between foveal morphology and self-perceived visual function in patients with neovascular age-related macular degeneration (AMD) and whether foveal characteristics are associated with Ranibizumab treatment response on the self-perceived visual function.MethodsThis prospective cohort study included patients with newly diagnosed neovascular AMD found eligible for treatment with Ranibizumab. Foveal morphology of both eyes was assessed using spectral-domain optical coherence tomography and all patients were interviewed using the 39-item National Eye Institute Visual Function Questionnaire (VFQ). Patients were re-interviewed 3 and 12 months after initiation of treatment with Ranibizumab. We evaluated foveal morphology at baseline in relation to VFQ scores at baseline and clinically meaningful changes in VFQ after 3 and 12 months.ResultsVFQ scores correlated with central foveal thickness, central foveal thickness of neuroretina (CFN), foveal RPE elevation, foveal integrity of the photoreceptor inner segment/outer segment junction (IS/OS), and external limiting membrane. In a multiple linear regression model, only best-corrected visual acuity of the better eye (p<0.001) and the IS/OS status in the better eye (p = 0.012) remained significant (Adjusted R2 = 0.418). Lower baseline VFQ and a baseline CFN within 170–270 µm in the better eye were both associated with a clinically meaningful increase in the VFQ scores after 3 and 12 months. An absent foveal IS/OS band in the better eye was associated with a clinically meaningful decrease in the VFQ scores at 12 months.ConclusionsFoveal morphology in the better eye influences the self-perceived visual function in patients with neovascular AMD and possesses a predictive value for change in the self-perceived visual function at 3 and 12 months after initiation of treatment. These findings may help clinicians provide patients more individualized information of their disease and treatment prognosis from a patient-perceived point-of-view.
Highlights
Age-related macular degeneration (AMD) is the leading cause of visual impairment among the elderly in the western world, and the late stages of the disease often lead to a severe negative impact on visual function
We need studies investigating disease impact and prognosis from a patient-perceived point-of-view. In this prospective cohort-study, we explored the relationship between baseline foveal characteristics and self-perceived visual function in patients with newly diagnosed neovascular AMD, and how baseline foveal characteristics are related to the self-perceived visual function after anti-VEGF treatment
Intra-rater reliability was high for all measured aspects of foveal characteristics: central foveal thickness (CFT) in the better eye (ICC = 0.996), central foveal thickness of neuroretina (CFN) in the better eye (ICC = 0.983), RPE elevation in the better eye (k = 1.000), inner segment/outer segment junction (IS/OS) status in the better eye (k = 0.964), external limiting membrane (ELM) status in the better eye (k = 0.935)
Summary
Age-related macular degeneration (AMD) is the leading cause of visual impairment among the elderly in the western world, and the late stages of the disease often lead to a severe negative impact on visual function. Characteristics of foveal morphology assist in predicting treatment response of anti-VEGF in the management of wet AMD, e.g. smaller lesion size at baseline predicts of a good treatment response, and interruptions in certain hyperreflective bands such as the photoreceptor inner segment/outer segment junction (IS/OS) and external limiting membrane (ELM) predicts a bad treatment response [14,15,16,17,18,19] Treatment response in these studies is measured as the change in visual acuity, which to the patient may be less relevant than the self-perceived visual function. We need studies investigating disease impact and prognosis from a patient-perceived point-of-view
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