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S. H. Sinclair, W. Li, P. Presti; Effect on High Contrast Discriminated Target Central Fields of Avastin Monotherapy for CNVM Due to AMD. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1781.
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© ARVO (1962-2015); The Authors (2016-present)
Vision outcomes for treatment of AMD CNVM have been previously evaluated using visual acuity with severe limitations. Central visual field testing with discriminated targets appears to offer significant advantages. This pilot study evaluated the short term effect of Avastin on CNVM due to AMD.
Thirty eyes of 29 patients underwent 3 courses of Avastin monotherapy at 6 week intervals and were evaluated prior to and 1 month following the last treatment with IVFA, OCT, best corrected ETDRS VA, and testing of central 10o radius visual fields with high contrast discriminated targets (MAVES interactive computer program). Angiograms were assessed for CNVM type and graded for amount of subretinal fluid, exudates, hemorrhage, severity of leakage, and RPE atrophy. OCT was evaluated for retinal thickness, presence of subretinal fluid and/or PED. Correlations were drawn between these and visual field alterations.
Among the 30 eyes, 20 had prior treatment with PDT and intravitreal triamcinolone or Macugen. 16 eyes demonstrated complete involution with minimal or no residual leakage but with variable fibrosis and RPE atrophy. In 7 eyes there was minimal or no response. Overall, best corrected visual acuity improved by 4.5 letters (0.08 logMAR), but among the 16 eyes with complete or partial regression, mean VA improved by 0.10 logMAR (6.33 letters) compared with 0.06 logMAR (2.14 letters) in those with a poor response. The MAVE central acuity (best acuity within 4 degrees radius of fixation) among all the eyes did not improve (0.00 logMAR) but improved 0.08 logMAR in those that responded compared to losing 0.06 logMAR in those eyes that did not respond. The MAVE global acuity (weighted average of threshold acuities across all intercepts) also showed minimal change overall while in 16 eyes that responded, improved by 0.05 logMAR decreased 0.1 logMAR in those that did not respond. OCT retinal thickness improved in all eyes by 25 microns, with no difference among those responding versus those that did not. Among the 16 eyes with complete or partial CNVM involution, discriminated target central fields demonstrated shrinkage of the central scotoma size in 12, no change in 4 and improvement in central scotoma density in 8. Resultant scotoma size or density was inversely associated with severity and area of RPE atrophy, residual exudates or hemorrhage, and fibrosis.
In this pilot study of Avastin treatment of CNVM due to AMD, central visual field testing with discriminated targets appears to offer improved understanding of retinal pathology and resulting vision.
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