Baseline Predictors for One-Year Visual Outcomes with Ranibizumab or Bevacizumab for Neovascular Age-related Macular Degeneration
Open accessAbstract
Objective To determine the baseline predictors of visual acuity (VA) outcomes 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD).Design Cohort study within the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).Participants A total of 1105 participants with neovascular AMD, baseline VA 20/25 to 20/320, and VA measured at 1 year.Methods Participants were randomly assigned to ranibizumab or bevacizumab on a monthly or as-needed schedule. Masked readers evaluated fundus morphology and features on optical coherence tomography (OCT). Visual acuity was measured using electronic VA testing. Independent predictors were identified using regression techniques.Main outcome measures The VA score, VA score change from baseline, and ≥3-line gain at 1 year.Results At 1 year, the mean VA score was 68 letters, mean improvement from baseline was 7 letters, and 28% of participants gained ≥3 lines. Older age, larger area of choroidal neovascularization (CNV), and elevation of retinal pigment epithelium (RPE) were associated with worse VA (all P<0.005), less gain in VA (all P<0.02), and a lower proportion gaining ≥3 lines (all P<0.04). Better baseline VA was associated with better VA at 1 year, less gain in VA, and a lower proportion gaining ≥3 lines (all P<0.0001). Predominantly or minimally classic lesions were associated with worse VA than occult lesions (66 vs. 69 letters; P=0.0003). Retinal angiomatous proliferans (RAP) lesions were associated with more gain in VA (10 vs. 7 letters; P=0.03) and a higher proportion gaining ≥3 lines (odds ratio, 1.9; 95% confidence interval, 1.2-3.1). Geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters; P=0.02). Eyes with total foveal thickness in the second quartile (325-425 μm) had the best VA (P=0.01) and were most likely to gain ≥3 lines (P=0.004). Predictors did not vary by treatment group.Conclusions For all treatment groups, older age, better baseline VA, larger CNV area, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, greater total fovea thickness, and RPE elevation on optical coherence tomography were independently associated with less improvement in VA at 1 year.Financial disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Predictors for poor response at 12 months include older age, better baseline acuity, larger CNV size, angiographic lesion type, absence of RAP, presence of GA, higher foveal thickness, PED, or elevation on OCT.
“It has been reported that predictors for poor response at 12 months include: older age, better baseline acuity, larger CNV size, angiographic lesion type, the absence of RAP and the presence of GA, in addition to higher foveal thickness, PED or elevation on OCT.21”
From Defining response to anti-VEGF therapies in neovascular AMD (2015) · cites this paper as [21]
The Abstract Conclusion identifies older age, better baseline acuity, larger CNV area, classic lesion type, absence of RAP, GA, greater foveal thickness, and RPE elevation as predictors of less visual-acuity improvement at one year. The Methods mention PED as a component of tissue measured on OCT, but the Discussion identifies foveal thickness and RPE elevation—not PED separately—as the independent OCT predictors. The Results also describe the relationship with foveal thickness as nonmonotonic, so ‘higher’ thickness is an oversimplification. (LLM, conf=0.87)
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- Authors
- Ying, G.-S., Huang, J., Maguire, M. G., Jaffe, G. J., Grunwald, J. E., Toth, C., Daniel, E., Klein, M., Pieramici, D., Wells, J., & Martin, D. F.
- Affiliations
- University of Pennsylvania (US)
- Duke University (US)
- Oregon Health & Science University (US)
- California Retina Consultants (US)
- Palmetto Retina Center (US)
- Cleveland Clinic (US)
- Corresponding author
- Ying, Gui-shuang
- ORCID
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 120
- Issue
- 1
- Pages
- 122-129
- ISSN
- 0161-6420 (ISSN-L)
- PMC
- PMC3536921
- OpenAlex
- W2165794331
- Cited by
- 305
- References
- 12
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 18 · 2023: 21 · 2022: 15 · 2021: 32 · 2020: 22 · 2019: 25 · 2018: 28 · 2017: 20 · 2016: 22 · 2015: 26 · 2014: 35 · 2013: 18
- FWCI
- 23.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Ophthalmology (publishedVersion, public-domain)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Eye Institute
- U.S. Department of Health and Human Services
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Keywords
- neovascular age-related macular degeneration, ranibizumab, bevacizumab, visual acuity outcomes, baseline predictors, choroidal neovascularization, retinal pigment epithelium elevation, geographic atrophy, foveal thickness, anti-VEGF therapy, visual acuity improvement
- MeSH terms
- Bevacizumab, Ranibizumab, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Humans, Male, Middle Aged, Time Factors, Visual Acuity, Cohort Studies, Treatment Outcome, Angiogenesis Inhibitors, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Wet Macular Degeneration, Intravitreal Injections, Antibodies, Monoclonal, Humanized
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