Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD

Usha Chakravarthy,Gidi Benyamini,Catherine Best,Alexandros Sagkriotis,Natasha Pillai,Emily Wilkes,Annie Syntosi,Moshe Havilio

doi:10.1038/s41433-020-01354-4

Usha Chakravarthy, Gidi Benyamini + Show 6 more

Open Access

https://doi.org/10.1038/s41433-020-01354-4

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Abstract

ObjectivesTo study the effect of repeated retinal thickness fluctuations during the anti-VEGF therapy maintenance phase in neovascular age-related macular degeneration (nAMD).MethodsData were extracted from electronic medical records of 381 nAMD patients, aged ≥50 years; baseline VA ≥33 and ≤73 letters; ≥24 months’ follow-up and ≥2 optical coherence tomography (OCT) measurements. OCT scans were analysed using an artificial intelligence algorithm that quantified the volumes of intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachments (PED) and central subfield thickness (CSFT). IRF, SRF and PED were summed to obtain total fluid (TF). The standard deviation (SD) of IRF, SRF, PED, CSFT and TF was computed and categorised into quartiles (SD-Q). Relationships between SD-Qs for each OCT feature and VA change was tested using generalised estimating equations and linear regression.ResultsBy Month 24, compared to SD-Q1, eyes in SD-Q2, SD-Q3, and SD-Q4 for IRF, SRF, PED, CSFT and TF showed greater VA losses. Eyes in SD-Q4 of TF were 9.4 letters worse compared to eyes in Q1 (95% Confidence Interval: −12.9 to −6.0). The frequency of clinic visits with IRF and SRF present on OCT scans by quartiles of CSFT was lower in eyes with least fluctuation (Q1) compared to eyes with the most fluid fluctuation (Q4) (median [IQR] IRF: 0.3 [0.0–0.7] versus 0.8 [0.5–1.0]; SRF: 0.0 [0.0–0.5] versus 0.6 [0.3–1.0]).ConclusionsGreater fluctuations in retinal fluid volumes during the maintenance phase of anti-VEGF treatment in nAMD is associated with worse VA by 2 years.

Highlights

IntroductionIs characterised by new blood vessel formation in the macula of the eye
Neovascular age-related macular degeneration, a late stage manifestation of age-related macular degeneration, Supplementary information The online version of this article contains supplementary material, which is available to authorised users.is characterised by new blood vessel formation in the macula of the eye
Clinical Data: This was a retrospective analysis of data obtained from a single site in the United Kingdom, with clinical information that had been captured in a standardised manner on the Medisoft electronic medical record (EMR) platform and integrated with optical coherence tomography (OCT) metrics obtained through artificial intelligence (AI) analysis of the corresponding image repository

Summary

Introduction

Is characterised by new blood vessel formation in the macula of the eye These new vessel complexes leak fluid and blood, distort the retinal architecture and result in sudden onset vision loss which, if left untreated, can progress rapidly to severe and permanent vision impairment [1]. Anti-vascular endothelial growth factor (anti-VEGF) therapies have become the standard of care for nAMD, resulting in improvement in vision and prevention of progression to severe vision loss in over 90% of treated patients over a 2 year period [2, 3]. Despite reductions in the incidence of blindness and severe vision loss since the introduction of anti-VEGF agents, long term follow up studies show that a proportion of eyes continue to lose visual acuity (VA) [5, 6]

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