June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Sustained Severe Visual Acuity Loss in the Comparison of AMD Treatments Trials (CATT)
Author Affiliations & Notes
  • Gui-Shuang Ying
    Ophthalmology, Scheie Eye Institute, Philadelphia, PA
  • Benjamin Kim
    Ophthalmology, Scheie Eye Institute, Philadelphia, PA
  • Maureen Maguire
    Ophthalmology, Scheie Eye Institute, Philadelphia, PA
  • Jiayan Huang
    Ophthalmology, Scheie Eye Institute, Philadelphia, PA
  • Ebenezer Daniel
    Ophthalmology, Scheie Eye Institute, Philadelphia, PA
  • Glenn Jaffe
    Ophthalmology, Duke University Medical Center, Durham, NC
  • Daniel Martin
    Cole Eye Institute, Cleveland Clinic, Cleveland, OH
  • Juan Grunwald
    Ophthalmology, Scheie Eye Institute, Philadelphia, PA
  • Footnotes
    Commercial Relationships Gui-Shuang Ying, None; Benjamin Kim, None; Maureen Maguire, Inspire Pharmaceuticals (F), Amakem (F), IDx LLC (F), Merck (C); Jiayan Huang, None; Ebenezer Daniel, None; Glenn Jaffe, Heidelberg Engineering (C), Regeneron Pharmaceuticals (F), Neurotech USA (C), Abbott (C), Psivida (F), Pfizer (C), Bayer (C); Daniel Martin, None; Juan Grunwald, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3659. doi:
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      Gui-Shuang Ying, Benjamin Kim, Maureen Maguire, Jiayan Huang, Ebenezer Daniel, Glenn Jaffe, Daniel Martin, Juan Grunwald, ; Sustained Severe Visual Acuity Loss in the Comparison of AMD Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2013;54(15):3659.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To determine the incidence, characteristics, causes and baseline predictors of sustained severe visual acuity (VA) loss during 2-years of anti-VEGF treatment in the Comparison of AMD Treatments Trials (CATT).

 
Methods
 

Participants were randomly assigned to treatment with ranibizumab or bevacizumab and to monthly injections for 2 years, PRN injections for 2 years, or monthly injections for 1 year and PRN injections the following year. Masked readers evaluated baseline and follow-up morphology in color fundus photographs (CFP), fluorescein angiograms (FA), and optical coherence tomography (OCT). Sustained severe VA loss was defined as VA loss of 15 letters or more from baseline at both weeks 104 and 88. Morphology features at baseline and 2 years were compared between eyes with vs. without sustained VA loss. A retina specialist reviewed image morphology to determine the likely cause of sustained VA loss.

 
Results
 

Among 1030 patients who completed 2 years of follow-up, 61 (6%) developed sustained VA loss of ≥3-lines, including 38 (4%) with sustained VA loss of ≥6-lines. At 2 years, eyes with sustained VA loss had more scarring and geographic atrophy (GA) on CFP and FA especially in the foveal center, and lesions were approximately twice as large (Table 1). On OCT at 2 years, the proportions with intraretinal fluid, subretinal fluid, retinal thinning/thickening, or subretinal hyper reflective material were higher, and retinal thickness or sub-RPE thickness were greater (Table 1). The cause of sustained VA loss included foveal scarring (41%), GA (12%), RPE tear (5%). Most of the remainder (28%) had non-elevated pigmentary abnormalities, some with retinal thinning (15%), and some with retinal thickening (7%). Independent baseline risk factors for sustained VA loss were the presence of GA, larger area of CNV, and bevacizumab treatment (Table 2).

 
Conclusions
 

Among CATT participants, sustained VA loss of ≥3-lines occurred in 6% of patients. The development of scar or GA in the fovea center contributed to the majority of the sustained VA loss after 2 years of treatment with ranibizumab or bevacizumab. Treatment targeting the prevention of scar or GA may improve the VA outcomes of anti-VEGF treatment.

 
 
Table 1: Comparison of morphology features at 2 Years between patients with and without sustained ≥3-lines VA loss
 
Table 1: Comparison of morphology features at 2 Years between patients with and without sustained ≥3-lines VA loss
 
 
Table 2 Multivariate Analysis for the baseline predictors of sustained ≥3-lines VA loss
 
Table 2 Multivariate Analysis for the baseline predictors of sustained ≥3-lines VA loss
 
Keywords: 412 age-related macular degeneration • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • 754 visual acuity  
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