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Macular Morphology and Visual Acuity in the Second Year of the Comparison of Age-Related Macular Degeneration Treatments Trials
Open accessAbstract
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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“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]
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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
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“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]
In the citing paper
“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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Metadata
- 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 › Ophthalmology › 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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