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Risk of Geographic Atrophy in the Comparison of Age-related Macular Degeneration Treatments Trials
Open accessAbstract
Purpose To describe risk factors for geographic atrophy (GA) in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).Design Cohort within a randomized clinical trial.Participants We analyzed 1024 CATT patients with no GA visible on color fundus photographs (CFPs) and/or fluorescein angiograms (FAs) at enrollment.Methods Eyes were assigned to ranibizumab (0.5 mg) or bevacizumab (1.25 mg) treatment and to a 2-year monthly or pro re nata (PRN) injection regimen, or monthly injections for 1 year and PRN for 1 year. Demographic, genetic, and baseline ocular characteristics and lesion features of CFP/FA and optical coherence tomography (OCT) were evaluated as risk factors for GA through 2 years of follow-up. Time-dependent Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs).Main outcome measures Development of GA.Results By 2 years, GA developed in 187 of 1024 patients (18.3%). Baseline risk factors for GA development included baseline visual acuity (VA) ≤20/200 (aHR, 2.65; 95% confidence interval [CI], 1.43-4.93), retinal angiomatous proliferation (RAP; aHR, 1.69; 95% CI, 1.16-2.47), GA in the fellow eye (aHR, 2.07; 95% CI, 1.40-3.08), and intraretinal fluid at the foveal center (aHR, 2.10; 95% CI, 1.34-3.31). Baseline factors associated with lower risk for GA development included blocked fluorescence (aHR, 0.49; 95% CI, 0.29-0.82), OCT measurements of subretinal fluid thickness of >25 μ (aHR, 0.52; 95% CI, 0.35-0.78), subretinal tissue complex thickness of >275 compared with ≤75 μ (aHR, 0.31; 95% CI, 0.19-0.50), and vitreomacular attachment (aHR, 0.55; 95% CI, 0.31-0.97). Ranibizumab compared with bevacizumab had a higher risk (aHR, 1.43; 95% CI, 1.06-1.93), and monthly dosing had a higher risk (aHR, 1.59; 95% CI, 1.17-2.16) than PRN dosing. There were no strong associations between development of GA and the presence of risk alleles for CFH, ARMS 2, HTRA1, C3, or TLR3.Conclusions Approximately one fifth of CATT patients developed GA within 2 years of treatment. Independent baseline risk factors included poor VA, RAP, foveal intraretinal fluid, monthly dosing, and treatment with ranibizumab. Anti-vascular endothelial growth factor therapy may have a role in the development of GA.
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“Unfortunately, up to 30% of patients can still have intraretinal fluid with vision loss after 1 year of therapy [2–4].”
From Thrombospondin-1, BIM and CFH polymorphisms and response to anti-VEGF treatment in neovascular age- related macular degeneration patients (2024) · cites this paper as [4]
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Metadata
- Authors
- Grunwald, J. E., Daniel, E., Huang, J., Ying, G.-S., Maguire, M. G., Toth, C. A., Jaffe, G. J., Fine, S. L., Blodi, B., Klein, M. L., Martin, A. A., Hagstrom, S. A., & Martin, D. F.
- Affiliations
- University of Pennsylvania (US)
- Duke University (US)
- University of Colorado Anschutz (US)
- University of Wisconsin–Madison (US)
- Oregon Health & Science University (US)
- Cleveland Clinic (US)
- Corresponding author
- Grunwald, Juan E.
- ORCID
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 121
- Issue
- 1
- Pages
- 150-161
- ISSN
- 0161-6420 (ISSN-L)
- PMC
- PMC3892560
- OpenAlex
- W2131192872
- Cited by
- 590
- References
- 46
- Citations by year
- 2026: 17 · 2025: 30 · 2024: 33 · 2023: 26 · 2022: 32 · 2021: 45 · 2020: 68 · 2019: 55 · 2018: 48 · 2017: 57 · 2016: 79 · 2015: 70 · 2014: 30
- FWCI
- 58.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Eye Institute (U10 EY017823, U10 EY017825, U10 EY017826, and U10 EY017828)
- National Institutes of Health
- 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 › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- geographic atrophy, age-related macular degeneration, risk factors, ranibizumab, bevacizumab, anti-VEGF therapy, intravitreal injection, retinal angiomatous proliferation, subretinal fluid, visual acuity, choroidal neovascularization, retinal pigment epithelium
- MeSH terms
- Bevacizumab, Ranibizumab, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Visual Acuity, Cohort Studies, Incidence, Proportional Hazards Models, Angiogenesis Inhibitors, Vascular Endothelial Growth Factor A, Geographic Atrophy, Wet Macular Degeneration, Genotyping Techniques, Antibodies, Monoclonal, Humanized
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