Predicting vision gains with anti-VEGF therapy in neovascular age-related macular degeneration patients by using low-luminance vision
Ronald E P Frenkel, Howard Shapiro, Ivaylo Stoilov, Ronald E P Frenkel, Howard Shapiro, Ivaylo Stoilov
Abstract
Background/aims: To evaluate baseline low-luminance visual acuity (LLVA) as a predictor of visual acuity improvement in patients with neovascular (wet) age-related macular degeneration (wAMD) receiving antivascular endothelial growth factor A (anti-VEGF) therapy.
Methods: In the HARBOR trial, 1084 treatment-naïve patients ≥50 years of age with subfoveal wAMD received intravitreal ranibizumab 0.5 or 2.0 mg monthly or as needed. To measure LLVA, patients read a normally illuminated ETDRS (Early Treatment Diabetic Retinopathy Study) chart with a neutral density filter placed in front of the study eye. Patients were assigned into quartiles based on the magnitude of the difference between best-corrected visual acuity under optimal luminance (BCVA) and LLVA (BCVA-LLVA gap). The association between mean change in BCVA from baseline and BCVA-LLVA gap at baseline was analysed using a general linear model.
Results: A smaller baseline BCVA-LLVA gap predicted significantly higher BCVA gains over 24 months (p<0.0001 at each month; Pearson correlation), even after controlling for baseline BCVA or stratifying by treatment arm. Patients in the smallest baseline BCVA-LLVA gap quartile gained an average of +13.4 letters compared with +2.4 letters for patients in the widest baseline BCVA-LLVA gap quartile. At months 12 and 24, the smallest baseline BCVA-LLVA gap quartile had the highest proportion of ≥15-≥30-letter gain, and the widest baseline BCVA-LLVA gap quartile had the highest proportion of ≥15-/≥30-letter loss (p<0.0001; Fisher's exact test).
Conclusions: The baseline BCVA-LLVA gap is a significant predictor of visual acuity response to anti-VEGF treatment in patients with wAMD.
Trial registration number: NCT00891735; Post-results.
Keywords: Degeneration; Drugs; Macula; Neovascularisation; Vision.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Figures
References
- Ho AC, Busbee BG, Regillo CD, et al. . Twenty-four-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration. Ophthalmology 2014;121:2181–92. 10.1016/j.ophtha.2014.05.009
- Boyer DS, Antoszyk AN, Awh CC, et al. . Subgroup analysis of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology 2007;114:246–52. 10.1016/j.ophtha.2006.10.045
- Kaiser PK, Brown DM, Zhang K, et al. . Ranibizumab for predominantly classic neovascular age-related macular degeneration: subgroup analysis of first-year ANCHOR results. Am J Ophthalmol 2007;144:850–7. 10.1016/j.ajo.2007.08.012
- Finger RP, Wickremasinghe SS, Baird PN, et al. . Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration. Surv Ophthalmol 2014;59:1–18. 10.1016/j.survophthal.2013.03.009
- Sunness JS, Rubin GS, Broman A, et al. . Low luminance visual dysfunction as a predictor of subsequent visual acuity loss from geographic atrophy in age-related macular degeneration. Ophthalmology 2008;115:1480–8, 8 e1–2 10.1016/j.ophtha.2008.03.009
- Busbee BG, Ho AC, Brown DM, et al. . Twelve-month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration. Ophthalmology 2013;120:1046–56. 10.1016/j.ophtha.2012.10.014
- Rosenfeld PJ, Brown DM, Heier JS, et al. . Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006;355:1419–31. 10.1056/NEJMoa054481
- Abedi F, Wickremasinghe S, Richardson AJ, et al. . Variants in the VEGFA gene and treatment outcome after anti-VEGF treatment for neovascular age-related macular degeneration. Ophthalmology 2013;120:115–21. 10.1016/j.ophtha.2012.10.006
- Brockmann C, Brockmann T, Dawczynski J. Influence of seasonal sunlight intensity and iris color on the anti-VEGF therapy for neovascular age-related macular degeneration. Eye (Lond) 2013;27:1169–73. 10.1038/eye.2013.159
- van Asten F, Rovers MM, Lechanteur YT, et al. . Predicting non-response to ranibizumab in patients with neovascular age-related macular degeneration. Ophthalmic Epidemiol 2014;21:347–55. 10.3109/09286586.2014.949010
- Suzuki M, Nagai N, Izumi-Nagai K, et al. . Predictive factors for non-response to intravitreal ranibizumab treatment in age-related macular degeneration. Br J Ophthalmol 2014;98:1186–91. 10.1136/bjophthalmol-2013-304670
- Ying GS, Huang J, Maguire MG, et al. . Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration. Ophthalmology 2013;120:122–9. 10.1016/j.ophtha.2012.07.042
- Smailhodzic D, Muether PS, Chen J, et al. . Cumulative effect of risk alleles in CFH, ARMS2, and VEGFA on the response to ranibizumab treatment in age-related macular degeneration. Ophthalmology 2012; 119:2304–11. 10.1016/j.ophtha.2012.05.040
- Abedi F, Wickremasinghe S, Richardson AJ, et al. . Genetic influences on the outcome of anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration. Ophthalmology 2013;120:1641–8. 10.1016/j.ophtha.2013.01.014
- Kim YM, Kim JH, Koh HJ. Improvement of photoreceptor integrity and associated visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol 2012;154:164–73.e1. 10.1016/j.ajo.2012.01.030
- Oishi A, Shimozono M, Mandai M, et al. . Recovery of photoreceptor outer segments after anti-VEGF therapy for age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013;251:435–40. 10.1007/s00417-012-2034-4
- Shin HJ, Chung H, Kim HC. Association between foveal microstructure and visual outcome in age-related macular degeneration. Retina (Philadelphia, Pa) 2011;31:1627–36. 10.1097/IAE.0b013e31820d3d01
- Eisner A, Klein ML, Zilis JD, et al. . Visual function and the subsequent development of exudative age-related macular degeneration. Invest Ophthalmol Vis Sci 1992;33:3091–102.
- Sandberg MA, Miller S, Gaudio AR. Foveal cone ERGs in fellow eyes of patients with unilateral neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 1993;34:3477–80.
- Lamb TD, Pugh EN Jr. Dark adaptation and the retinoid cycle of vision. Prog Retin Eye Res 2004;23:307–80. 10.1016/j.preteyeres.2004.03.001
- Jackson GR, Owsley C, McGwin G Jr. Aging and dark adaptation. Vision Res 1999;39:3975–82. 10.1016/S0042-6989(99)00092-9
Source: PubMed