Purpose:
To determine baseline predictors of visual acuity (VA) outcomes at 1 year after treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration.
Methods:
Participants were randomly assigned to receive ranibizumab or bevacizumab on either a monthly schedule or as needed with monthly evaluation. Masked trained readers evaluated fundus morphology, optical coherence tomography (OCT) fluid and retinal thickness. Predictors were identified using multiple regression for VA score, VA score change from baseline, and % of ≥3-line gain (%3LG) at 1 year.
Results:
Older age, larger CNV area and presence of RPE elevation were all associated with worse VA (all p<0.006), less gain in VA (all p<0.02) and lower %3LG (all p<0.04). Better VA at baseline was associated with better VA at 1 year, less gain in VA, and lower %3LG (all p<0.0001). Predominantly or minimally classic lesion was associated with worse VA than occult lesion (66 vs. 69 letters, p=0.0003). Presence of RAP lesion was associated with more gain in VA (10 vs. 7 letters, p=0.008) and higher %3LG (OR=1.9, 95% CI: 1.2 - 3.1). Presence of geographic atrophy (GA) was associated with worse VA (64 vs. 68 letters, p=0.001). Abnormal intraocular pressure (IOP) was associated with worse VA (p=0.002) and less gain in VA (p=0.03). Eyes having a total foveal thickness in the 2nd quartile (325 - 425 microns) had the best visual acuity (p=0.02) and were most likely to gain ≥3 lines (p=0.004).
Conclusions:
Among CATT participants, older age, better baseline VA, larger area of CNV, predominantly or minimally classic lesion, absence of RAP lesion, presence of GA, abnormal IOP, thicker total fovea thickness and presence of RPE elevation were independently associated with less gain in VA after 1 year of treatment with ranibizumab or bevacizumab.
Clinical Trial:
http://www.clinicaltrials.gov NCT00593450
Keywords: age-related macular degeneration • vascular endothelial growth factor • visual acuity