Macular Morphology and Visual Acuity in Year Five of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).

Research paper by Glenn J GJ Jaffe, Gui-Shuang GS Ying, Cynthia A CA Toth, Ebenezer E Daniel, Juan E JE Grunwald, Daniel F DF Martin, Maureen G MG Maguire,

Indexed on: 07 Sep '18Published on: 07 Sep '18Published in: Ophthalmology


To evaluate associations of morphologic features with 5-year visual acuity (VA) in the Comparison of Age-related Macular Degeneration (AMD) Treatments Trials (CATT). Cohort study within a randomized clinical trial. Participants in CATT. Eyes with AMD-associated choroidal neovascularization (CNV) and VA between 20/25 and 20/320 were eligible. Treatment was assigned randomly to ranibizumab or bevacizumab and to 3 dosing regimens for 2 years and was at the ophthalmologists' discretion thereafter. VA; thickness and morphological features on optical coherence tomography; lesion size and foveal composition on fundus photography and fluorescein angiography. VA and image gradings were available for 523 of 914 (57%) participants alive at 5 years. At 5 years, 60% of eyes had intraretinal fluid (IRF), 38% had subretinal fluid (SRF), 36% had sub-retinal pigment epithelium (RPE) fluid, and 66% had subretinal hyper-reflective material (SHRM). Mean (SD) foveal center thickness (μm) was 148 (99) for retina, 5 (21) for SRF, 125 (107) for subretinal tissue complex, 11 (33) for SHRM, and 103 (95) for RPE+RPE elevation. SHRM, thinner retina, greater CNV lesion area and foveal center pathology (all p<0.001) and IRF (p<0.05), were independently associated with worse VA. Adjusted mean VA letters was 62 for no pathology in the foveal center, 61 for CNV, fluid, or hemorrhage, 65 for non-geographic atrophy (GA), 64 for non-fibrotic scar, 53 for GA, and 56 for fibrotic scar. Incidence or worsening of eight pathological features (foveal GA, foveal scar, foveal CNV, SHRM, foveal IRF, retinal thinning, CNV lesion area, and GA area) between years 2 and 5 were independently associated with greater loss of VA from year 2 to 5, and VA loss from baseline to year 5 . Associations between VA and morphologic features previously identified through year 1 were maintained or strengthened at year 5. New foveal scar, CNV, intraretinal fluid, SHRM and retinal thinning, development or worsening of foveal GA, and increased lesion size, are important contributers to the VA decline from year 2 to 5. A significant need to develop therapies to address these adverse pathological features remains. Copyright © 2018. Published by Elsevier Inc.