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Gui-Shuang Ying, Maureen G Maguire, Wei Pan, Juan E Grunwald, Ebenezer Daniel, Glenn J Jaffe, Cynthia A Toth, Daniel F Martin; Baseline Predictors of Five-Year Visual Acuity in the Comparison of AMD Treatment Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2017;58(8):886.
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To determine baseline predictors of visual acuity (VA) outcomes at 5 years after initiating treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration.
Participants were randomly assigned to receive ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After two years, patients were released from the clinical trial protocol, and were recalled for examination at 5 years. Masked trained readers evaluated baseline fundus morphology on color photographs and fluorescein angiography, fluid within and thickness of the retina on time-domain optical coherence tomography (TD-OCT). Outcomes for the study eye at 5 years included VA score, VA score change from baseline, ≥3-line gain, ≥3-line loss, and VA 20/200 or worse. Predictors (demographics, ocular characteristics, and OCT measures) were screened using univariate analysis. Independent predictors were identified with multiple regression analysis using a backward selection method.
Among 647 patients with VA outcomes at 5 years, the mean VA score at 5 years was 59 letters, with a mean decrease of 3.3 letters from baseline, 17.6% with ≥3-line gain, 23.6% with ≥3-line loss, and 20% with 20/200 or worse. In multivariate analysis (Tables 1&2), worse baseline VA was associated with worse VA, more VA gain, higher percentage of ≥3-lines gain, and higher percentage of 20/200 or worse at 5 years (all p<0.001); larger baseline CNV lesion area was associated with worse VA, larger VA loss, higher percentage of ≥3-lines loss, and higher percentage of 20/200 or worse at 5 years (all p<0.05); absence of subretinal fluid was associated with worse VA (p=0.03) and larger VA loss (p=0.03); female gender, bevacizumab treatment in the first 2 years, and absence of RPE elevation were associated with a higher percentage of ≥3-line gain; cigarette smoking was associated with a higher percentage with 20/200 or worse.
At 5 years after initiating treatment with ranibizumab or bevacizumab in CATT participants, male gender, cigarette smoking, treatment with ranibizumab in the first 2 years, larger area of CNV lesion, absence of sub-retinal fluid and presence of RPE elevation at baseline are independently associated with worse vision outcomes at 5 years; while worse baseline VA in study eye was independently associated with worse 5-year VA and more VA gain from baseline.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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