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Cited by 708Retinal Diseases and TreatmentsRetinal and Macular SurgeryOcular Diseases and Behçet’s Syndrome

The DOI matches its Crossref record; 48 of the 48 references it cites were found in a registry or an index; none of the 55 sources its claims cite is checked for support yet.

Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration

Open access
Maguire, Maureen G., Martin, Daniel F., Ying, Gui-shuang, Jaffe, Glenn J., Daniel, Ebenezer, Grunwald, Juan E., Toth, Cynthia A., Ferris, Frederick L., Fine, Stuart L.·2016·Ophthalmology
DOI 10.1016/j.ophtha.2016.03.045PMC PMC4958614
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Abstract

Purpose To describe outcomes 5 years after initiation of treatment with bevacizumab or ranibizumab for neovascular age-related macular degeneration (AMD). Design Cohort study.. Participants Patients enrolled in the Comparison of AMD Treatments Trials (CATT). Methods Patients were randomly assigned to ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After 2 years, patients were released from the clinical trial protocol. At approximately 5 years, patients were recalled for examination. Main Outcome Measures Visual acuity (VA) and morphologic retinal features. Results VA was obtained for 647 (71%) of 914 living patients with average follow-up time 5.5 years. The mean number of examinations for AMD care after the clinical trial ended was 25.3, and the mean number of treatments in the study eye was 15.4. Most (60%) patients were treated ≥1 times with a drug other than their randomly assigned drug. At the 5-year visit, 50% of study eyes had VA 20/40 or better and 20% had VA 20/200 or worse. Mean change in VA was −3 letters from baseline and −11 letters from 2 years. Among 467 eyes with fluorescein angiography, mean total lesion area was 12.9 mm2, a mean of 4.8 mm2 larger than at 2 years. Geographic atrophy was present in 213 (41%) of 515 gradable eyes and was subfoveal in 85 (17%). Among 555 eyes with spectral domain optical coherence tomography, 83% had fluid (61% intraretinal, 38% subretinal, and 36% sub-retinal pigment epithelium). Mean foveal total thickness was 278 μm; a decrease of 182 μm from baseline and 20 μm from 2 years. An abnormally thin retina at the foveal center (<120 μm) was present in 36%. Between 2 and 5 years, the group originally assigned to ranibizumab for 2 years lost more VA than the bevacizumab group (−4 letters; p=0.008). Otherwise, there were no statistically significant differences in VA or morphological outcomes between drug or regimen groups. Conclusion Vision gains during the first 2 years of the trial were not maintained at 5 years. However, 50% of eyes had VA 20/40 or better, confirming anti-VEGF therapy as a major long-term therapeutic advance for neovascular AMD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

At about five years after starting anti-VEGF therapy in CATT, visual gains achieved during the first two years were not sustained, with mean acuity falling below baseline. Nevertheless, roughly half of examined eyes still had 20/40 or better vision, supporting long-term benefit despite progressive retinal and lesion changes.

Key findings

  • Among 914 living CATT participants, 647 (70.8%) had visual acuity measured at a mean of 5.5 years; mean change was −3.3 letters from baseline and −10.8 letters from year 2.
  • At follow-up, 49.6% of eyes had 20/40 or better acuity and about 20% had 20/200 or worse; mean acuity was 58.9 letters (approximately 20/63).
  • Morphologic worsening was common: 83.0% had fluid on OCT, 41.4% had geographic atrophy (16.5% subfoveal), mean total lesion area was 12.9 mm² (4.8 mm² larger than at 2 years), and 36.2% had foveal retinal thickness below 120 μm.
  • Eyes originally assigned to ranibizumab lost more acuity between years 2 and 5 than those originally assigned to bevacizumab (−12.7 vs −8.8 letters; p=0.008); after trial release, arteriothrombotic events were reported in 7.6% of ranibizumab-origin patients versus 4.5% of bevacizumab-origin patients (p=0.04), though no such difference appeared during the randomized trial period.

Methods

  • This was a follow-up cohort study of patients from the CATT randomized trial, which compared ranibizumab and bevacizumab and monthly versus as-needed dosing for neovascular AMD.
  • After the 2-year trial protocol ended, patients were recalled for examination between 2014 and 2015; analyses included those with visual acuity measured 51–85 months after treatment assignment.
  • Outcomes included visual acuity, OCT morphology, fundus photography, fluorescein angiography, treatment history, and serious medical events; comparisons used analysis of variance and chi-square tests.

Limitations

  • The paper states that only 70.8% of living participants returned, and that returning patients were younger and had better baseline and 2-year acuity than nonparticipants, so results likely overestimate outcomes for the full CATT population.
  • The paper also notes missing imaging among participants (about 14% without OCT, 19% without color photographs, and 28% without fluorescein angiography), limiting generalizability of morphologic findings.
  • Because most patients changed drugs or dosing after trial release, the study provides limited ability to compare long-term drug or regimen effects; the text makes evident that post-protocol care was observational and not randomized.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.ophtha.2016.03.045

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 55 cited sources checked · 0 supported · 0 flagged

Show all 75 claims

  • Probably not a substantial claim. 11
  • It may state two separate claims as one. 26
35 of 35

  • The paper relies on this without support.

    Visual acuity measurements obtained from outside ophthalmologists are comparable to those obtained at CATT centers.

    “Information on treatment, visual acuity, and imaging was requested from the outside ophthalmologists who provided AMD care for these patients.”
    “Most (85.5%) of the visual acuity information was obtained by examination at a CATT clinical center by a certified examiner.”

  • The paper relies on this without support.

    The observed 5-year visual outcomes are attributable to anti-VEGF treatment rather than to other factors or the natural history of neovascular AMD.

    “However, 50% of eyes had VA 20/40 or better, confirming anti-VEGF therapy as a major long-term therapeutic advance for neovascular AMD.”

  • The authors state this as an assumption.

    Residual fluid was often minor, missed by the clinician, or accepted because vision was stable.

    “it is reasonable to assume that the amount of fluid was frequently small and not detected by the ophthalmologist or was tolerated because of stable vision.”

  • The paper relies on this without support.

    Worse visual acuity outcomes are associated with increased lesion size.

    “Worse VA outcomes have also been associated with increased lesion size”
4 of 4

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Metadata

Authors
Maguire, M. G., Martin, D. F., Ying, G.-S., Jaffe, G. J., Daniel, E., Grunwald, J. E., Toth, C. A., Ferris, F. L., & Fine, S. L.
Affiliations
  • University of Pennsylvania (US)
  • Cleveland Clinic (US)
  • Duke University (US)
  • National Institutes of Health (US)
  • University of Colorado Denver (US)
Corresponding author
Maguire, Maureen G.
ORCID
Venue
Ophthalmology
Publisher
Elsevier BV
Published
2016-08
Volume
123
Issue
8
Pages
1751-1761
ISSN
0161-6420 (ISSN-L)
DOI
10.1016/j.ophtha.2016.03.045
PMC
PMC4958614
OpenAlex
W2343042175
Semantic Scholar
1942346571be9df28fbc5ab3a269cdee1dd46caa
Cited by
708
References
48
Citations by year
2026: 33 · 2025: 72 · 2024: 60 · 2023: 63 · 2022: 63 · 2021: 94 · 2020: 110 · 2019: 74 · 2018: 60 · 2017: 64 · 2016: 13
FWCI
74.40
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Eye Institute (U10EY017825, U10EY017826, U10EY017823, U10EY023530, U10EY017828)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Ophthalmology › Retinal and Macular Surgery
  • Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
Keywords
neovascular age-related macular degeneration, anti-VEGF therapy, bevacizumab, ranibizumab, long-term visual outcomes, visual acuity, geographic atrophy, retinal thickness, subretinal fluid, retinal pigment epithelium, dosing regimen
MeSH terms
Bevacizumab, Ranibizumab, Aged, Aged, 80 and over, Female, Fluorescein Angiography, Follow-Up Studies, Humans, Male, Prospective Studies, Retina, Visual Acuity, Cohort Studies, Treatment Outcome, Angiogenesis Inhibitors, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Geographic Atrophy, Wet Macular Degeneration, Intravitreal Injections, Subretinal Fluid

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