June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Visual acuity impairment under low luminance conditions at baseline is a powerful predictor of visual acuity response to ranibizumab therapy in patients with neovascular age-related macular degeneration
Author Affiliations & Notes
  • Marc C. Peden
    Retina Associates of Florida, Tampa, FL
    Department of Ophthalmology, University of Florida, Gainesville, FL
  • Ronald E P Frenkel
    Bascom Palmer Eye Institute, Miami, FL
    East Florida Eye Institute, Stuart, FL
  • Howard Shapiro
    Genentech, Inc., South San Francisco, CA
  • Ivaylo Stoilov
    Genentech, Inc., South San Francisco, CA
  • Footnotes
    Commercial Relationships Marc Peden, Genentech, Inc. (F); Ronald Frenkel, Aerpio (F), Alcon (F), Allergan (F), Bausch and Lomb (F), Genentech, Inc. (F), GlaxoSmithKline (F), L-Path (F), Pfizer (F), Regeneron (F), Rigel (F); Howard Shapiro, Genentech, Inc. (E); Ivaylo Stoilov, Genentech, Inc. (E)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 5362. doi:
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    • Get Citation

      Marc C. Peden, Ronald E P Frenkel, Howard Shapiro, Ivaylo Stoilov; Visual acuity impairment under low luminance conditions at baseline is a powerful predictor of visual acuity response to ranibizumab therapy in patients with neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5362.

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

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Abstract

Purpose: To explore the impact of the baseline difference in visual acuity measured in normal and low luminance conditions (BCVA-LLVA gap) on the capacity of patients with neovascular age-related macular degeneration (AMD) to gain vision with ranibizumab therapy.

Methods: The HARBOR study (NCT00891735) evaluated the efficacy and safety of intravitreal ranibizumab 0.5 mg and 2.0 mg given monthly or as-needed (PRN) in patients with neovascular AMD. LLVA was measured by placing a 2.0-log-unit neutral density filter in front of the study eye and having the participant read the normally illuminated ETDRS chart. For this analysis, the study participants (N=1084) were pooled and divided into quartiles based on the magnitude of the BCVA-LLVA gap at baseline. The association between BCVA-LLVA gap and BCVA gains was analyzed using a general linear model.

Results: The baseline BCVA-LLVA gap was negatively correlated with BCVA gain at Month 24 (P<0.0001); the significant association remained after controlling for baseline BCVA, as well as after stratifying by ranibizumab treatment group (0.5 mg or 2.0 mg; monthly or PRN). Patients with the narrowest BCVA-LLVA gap (smallest difference in vision under low luminance) at baseline gained, on average, 13.4 letters in BCVA at Month 24 (versus 2.4 letters in patients with the widest BCVA-LLVA gap at baseline) (Figure). Almost twice as many patients with the smallest baseline BCVA-LLVA gap gained ≥15 letters at Month 24 (49%) compared with patients with the widest baseline BCVA-LLVA gap (26%). Patients with the widest BCVA-LLVA gap at baseline also had the greatest PED, lesion, CNV and subretinal fluid thickness at baseline (P<0.05, based on a general linear model).

Conclusions: The BCVA-LLVA gap at baseline was prognostic for treatment response in patients with neovascular AMD. A narrow BCVA-LLVA gap may be a manifestation of milder retinal impairment and a predictor of greater capacity for visual function recovery with ranibizumab therapy. There is a good association between function as measured by the baseline visual gap and structure as measured by baseline OCT.

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