Macular Morphology and Visual Acuity in the Second Year of the Comparison of Age-Related Macular Degeneration Treatments Trials

Abstract

Purpose: To describe the association between morphologic features on fundus photography (FP), fluorescein angiography (FA), and optical coherence tomography (OCT) and visual acuity (VA) in the second year of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).

Design: Prospective cohort study within a randomized clinical trial.

Participants: Participants in the CATT.

Methods: Study eye eligibility required angiographic and OCT evidence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and VA between 20/25 and 20/320. Treatment was assigned randomly to ranibizumab or bevacizumab with 3 different dosing regimens over a 2-year period.

Main outcome measures: Fluid type, location, and thickness; retina and subretinal tissue complex thickness on OCT; size and lesion composition on FP and FA; and VA.

Results: Among 1185 CATT participants, 993 (84%) had fluid on OCT at baseline and completed 2 years of follow-up. At 2 years, intraretinal fluid (IRF), subretinal fluid (SRF), sub-retinal pigment epithelium (RPE) fluid, and subretinal tissue complex thickness decreased in all treatment groups. Ranibizumab monthly was best able to resolve each type of fluid. Eyes with SRF in the foveal center on OCT had better mean VA than eyes with no SRF (72.8 vs. 66.6 letters; P = 0.006). Eyes with IRF in the foveal center had worse mean VA than eyes without IRF (59.9 vs. 70.9 letters; P < 0.0001). Eyes with retinal thickness <120 μm had worse VA compared with eyes with retinal thickness 120 to 212 and >212 μm (59.4 vs. 71.3 vs. 70.3 letters; P < 0.0001). At 2 years, the mean VA (letters) of eyes varied substantially by the type of subfoveal pathology on FP and FA: 70.6 for no pathology; 74.1 for fluid only; 73.3 for CNV or pigment epithelial (RPE) detachment; 68.4 for nongeographic atrophy; and 62.9 for geographic atrophy, hemorrhage, RPE tear, or scar (P < 0.0001).

Conclusions: The associations between VA and morphologic features identified through year 1 were maintained or strengthened during year 2. Eyes with foveal IRF, abnormally thin retina, greater thickness of the subretinal tissue complex on OCT, and subfoveal geographic atrophy or scar on FP/FA had the worst VA. Subretinal fluid was associated with better VA.

Trial registration: ClinicalTrials.gov NCT00593450.

Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Percentage in each treatment group over time with fluid of any type (A), intraretinal fluid (B), subretinal fluid (C), and sub–retinal pigment epithelium fluid (D). PRN = pro re nata.

Figure 2

Optical coherence tomography thickness over time by treatment group for total thickness (A), retinal thickness (B), subretinal thickness (C), and subretinal tissue complex thickness (D). PRN = pro re nata.

Figure 3

Retinal thickness category over time by treatment group. PRN = pro re nata.

Figure 4

Involvement of the foveal center by choroidal neovascularization (CNV) or sequelae of CNV at week 104 (N = 983). RPE = retinal pigment epithelium; SPED = serous retinal pigment epithelial detachment.

Figure 5

Involvement of the foveal center by choroidal neovascularization (CNV) or sequelae of CNV at week 104 for ranibizumab monthly (A), bevacizumab monthly (B), ranibizumab pro re nata (PRN) (C), bevacizumab PRN (D), ranibizumab PRN always (E), and bevicizumab PRN always (F). RPE = retinal pigment epithelium; SPED = serous retinal pigment epithelial detachment.

Figure 6

Mean visual acuity by status of fluid by time for fluid of any type (A), intraretinal fluid (B), subretinal fluid (C), and sub–retinal pigment epithelium fluid (D).

Figure 7

Relationship between retinal thickness and visual acuity at baseline and follow-up: foveal total thickness (A), retinal thickness (B), subretinal thickness (C), and subretinal tissue complex thickness (D).