Structural Responses on OCT Not Predictive of Long-Term Visual Acuity in nAMD Eyes

Most structural responses on optical coherence tomography at 3 months were not independently predictive of the 2-year best-corrected visual acuity (BCVA) responses in eyes with neovascular age-related macular degeneration (nAMD), according to new research.¹

Investigators from the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT) Research Group indicated the 2-year BCVA responses were associated with baseline factors and the 3-month BCVA response to anti-vascular endothelial growth factor therapy (VEGF).

“A combination of baseline predicts, early BCVA, and morphological responses at 3 months only moderately predicted the long-term BCVA responses,” wrote the investigative team, led by Gui-shuang Ying, MD, PhD, for the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group.

Estimates suggest that the global burden of AMD will increase to approximately 300 million people by 2040, due to increases in life expectancy.² Data has indicated a higher prevalence of early disease in those of European ancestry, while late prevalence increases rapidly after 75 years of age. Asia is expected to see the largest amount of people with the condition, despite having the lowest prevalence currently.

In this analysis, Ying and colleagues set out to predict 2-year visual acuity responses to anti-VEGF therapy, using early morphologic and functional responses in patients with nAMD. The cohort consisted of patients within a randomized clinical trial. Investigators identified 1185 participants with untreated active nAMD and BCVA from 20/25 to 20/320 at baseline.

The study was a secondary analysis of data from individuals randomized to either ranibizumab or bevacizumab and to 1 of 3 dosing regimens. Investigators assessed the associations of 2-year BCVA responses with baseline morphologic and functional characteristics and their change from baseline at 3 months. They used univariable and multivariable linear regression models for BCVA change and logistic regression models for ≥3-line BCVA gain from baseline.

Moreover, the performance of predictions for 2-year BCVA outcomes using these characteristics was assessed using R2 for BCVA change and area under the receiver operating characteristic curve (AUC) for ≥3-line BCVA gain. The main outcome measures for the study were change in BCVA and ≥3 line-gain from baseline at 2 years.

Multivariable analyses included previously reported significant baseline predictors, including baseline BCVA, baseline macular atrophy, baseline retinal pigment epithelium elevation (RPEE), maximum width, and early BCVA change from baseline at 3 months. Upon analysis, new RPEE occurrence at 3 months was found significantly associated with more BCVA gain at 2 years (10.2 letters vs. 3.5 letters for RPEE resolved; P <.001). Meanwhile, none of the other morphologic responses at 3 months were significantly associated with BCVA responses at 2 years.

Data showed the significant predictors only moderately predicted 2-year BCVA gain was an R2 of 0.36. Analyses showed the baseline BCVA and ≥3-line BCVA gain at 3 months predicted 2-year ≥3-line gain with AUC of 0.83 (95% CI, 0.81 – 0.86).

“Future research is needed to better understand the factors contributing to the variation in long-term vision outcomes with anti-VEGF therapy,” investigators wrote.

References

1. Xue K, Hua P, Maguire MG, et al. Prediction for 2-Year Vision Outcomes Using Early Morphologic and Functional Responses in the Comparison of Age-related Macular Degeneration Treatments Trials. Ophthalmol Retina. 2023;7(7):564-572. doi:10.1016/j.oret.2023.02.008
2. Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(2):e106-e116. doi:10.1016/S2214-109X(13)70145-1