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michele arthurs, Richard Rosen, Gennady Landa, Rishard Weitz, William Seiple; Monitoring the Progression of AMD post anti-VEGF treatment using the OPKO OCT/SLO. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5027.
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To evaluate the outcome of anti-VEGF treatment in patients with exudative age-related macular degeneration (AMD) using the optical coherence tomography-scanning light ophthalmoscope (OCT/SLO), and to determine if predictors of an individual patient’s responses to treatment can be identified.
Patients diagnosed with exudative AMD and having received no prior AMD treatment were recruited. Eight subjects between 58 and 85 years of age with visual acuities ranging between 20/16 and 20/200 were enrolled. Monthly treatments of ranibizumab were given in the affected eye for up to 12 months. Three measures of local retinal function were obtained monthly using the OPKO OCT/SLO: retinal structure (OCT), psychophysical function (microperimetry), and fixation location and stability. Integrity of outer layers and retinal thickness were obtained with the OCT from line scans and from 3D topographies. Psychophysical sensitivity (in decibels) was measured with fundus-tracking microperimetry. A circular pattern of 28 test locations covering the central 11 degrees of the macula was used. Stimulus duration was 200ms, at an average interval of two seconds, and at a Goldmann III size. Fixation locations were recorded during 20 seconds of viewing an “X.” Fixation stability was calculated by fitting a Bivariate Contour Ellipse Area to these data.
Thickness remained stable post-treatment in half of the patients whereas the other half demonstrated an initial drop after the first injection and remained stable after subsequent visits. A qualitative assessment of OCT suggests that the integrity of the IS/OS layer did not improve if it appeared disrupted at baseline visit. Sensitivity increased across all visits for one patient(12.5%), increased for two patients in later visits(25%), remained stable in three patients(37.5%), decreased slightly in one patient(12.5%), and more importantly in the last patient(12.5%). While fixation location was variable for all subjects, fixation stability (BCEA area) slightly improved in one patient(12.5%), did not change in five patients(62.5%), and was quite variable for two patients(25%).
Our data suggests that thickness and sensitivity were predictors in evaluating outcome of anti-VEGF treatment. Fixation did not show a significant improvement in stability post-treatment and fixation location tended to vary between visits indicating the possibility of more than one PRL.
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