Macular Morphology and Visual Acuity in the Second Year of the Comparison of Age-Related Macular Degeneration Treatments Trials
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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.
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In CATT, macular atrophy and foveal scar were previously reported as the two foremost morphological outcomes tied to poor visual acuity.
“We have previously reported that both macular atrophy and foveal scar are the two foremost morphological outcomes associated with poor visual acuity in CATT.9”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [9]
The Discussion (page unavailable) identifies foveal scar and foveal geographic atrophy among the features associated with the largest decreases in visual acuity in CATT. It also names several other features in that group, so it does not establish atrophy and scar as the two foremost outcomes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredScars thicker than 0.2 mm have been linked to extensive loss of photoreceptors overlying the scar.
“Scars thicker than 0.2 mm have been associated with large scale loss of the photoreceptors overlying the scar tissue.8, 9”
From Development and Course of Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials (2018) · cites this paper as [9]
The Results sections on OCT thickness and fundus features report that thicker subretinal tissue complexes and foveal scars were associated with worse visual acuity. They do not report a 0.2 mm scar-thickness threshold or loss of photoreceptors overlying a scar; searches for those terms found no such passage in our copy. Page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measuredCross-sectionally, eyes with intraretinal fluid have worse visual acuity during anti-VEGF therapy, whereas those with subretinal fluid have better visual acuity.
“On a cross-sectional basis, the presence of intraretinal fluid is associated with worse visual acuity during anti-VEGF treatment while the presence of subretinal fluid is associated with better visual acuity.36–38”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [37]
Geographic atrophy affected 20% of eyes at 2 years and 41% at 5 years; subfoveal geographic atrophy rose from 6% to 17%.
“We also previously reported that the proportion of eyes with geographic atrophy was 20% at 2 years and this proportion increased to 41% at 5 years, with an increase in subfoveal geographic atrophy from 6% to 17%.7,37”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [37]
Retinal thinning to <120 microns was associated with worse visual acuity outcomes at 1 and 2 years.
“We previously reported that retinal thinning to <120 microns was associated with worse VA outcomes at 1 and 2 years.36,37”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [37]
Eyes with abnormally thin retina rose from 22% at Year 2 to 36% at 5 years.
“The proportion of eyes with an abnormally thin retina increased from 22% at the end of Year 2 to 36% at 5 years.37”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [37]
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- Authors
- Sharma, S., Toth, C. A., Daniel, E., Grunwald, J. E., Maguire, M. G., Ying, G.-S., Huang, J., Martin, D. F., & Jaffe, G. J.
- Affiliations
- Duke University (US)
- University of Pennsylvania (US)
- Cleveland Clinic (US)
- Corresponding author
- Jaffe, Glenn J.
- ORCID
- Venue
- Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 123
- Issue
- 4
- Pages
- 865-875
- ISSN
- 0161-6420 (ISSN-L)
- PMC
- PMC4998967
- OpenAlex
- W2225799082
- Cited by
- 231
- References
- 10
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 21 · 2023: 21 · 2022: 31 · 2021: 40 · 2020: 32 · 2019: 13 · 2018: 17 · 2017: 20 · 2016: 9
- FWCI
- 20.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Eye Institute (U10EY017825, U10EY017826, R21EY023689, U10EY017823, U10EY017828)
- 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
- age-related macular degeneration, choroidal neovascularization, visual acuity, intraretinal fluid, subretinal fluid, ranibizumab, bevacizumab, anti-VEGF therapy, fundus photography, fluorescein angiography, optical coherence tomography
- MeSH terms
- Bevacizumab, Ranibizumab, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Humans, Macula Lutea, Male, Photography, Prospective Studies, Visual Acuity, Cohort Studies, Choroidal Neovascularization, Angiogenesis Inhibitors, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Retinal Pigment Epithelium, Geographic Atrophy, Wet Macular Degeneration, Intravitreal Injections, Subretinal Fluid
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