Hard Exudates and Treatment Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Abstract

Purpose : To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with baseline hard exudates (HE) and all other eyes among patients with naive neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factors (anti-VEGF).

Methods : Certified readers evaluated baseline and follow-up morphology on digital color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT) in eyes with nAMD that were randomly assigned to treatment with either ranibizumab or bevacizumab in a prospective cohort study. Ophthalmologists identified HE on color and red-free images.

Results : HE were present in 128 of 1185 (11%) study eyes at baseline, 77% within 1 disc diameter area of the foveal center. HE patients were more likely female (81% vs 60%; p<0.001), non-smokers (53% vs 42%; p=0.004), and less likely to have a history of myocardial infarction (6% vs 13%; p=0.02). Both groups had similar proportions with hypertension, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and congestive heart failure. At baseline, eyes with HE had worse VA (mean 57 vs 61 letters p=0.003), larger choroidal neovascularization (CNV) (2.2 vs 1.7 disc areas [DA]; p<0.004) and total lesion size (3.3 vs 2.4 DA; p <0.001), greater total retinal thickness (522 µm vs 452µm; p<0.001), more retinal angiomatous proliferation (18% vs 10%; p=0.009) and sub-RPE fluid (65% vs 47%; p<0.001). At 1 year, VA was similar in both groups; more eyes with HE at baseline had no fluid (45% vs 29%; p<0.001) and a greater reduction in mean total foveal thickness (-266 µm vs -158um, p<0.001). VA at year 2 remained similar between the two groups, but retinas with HE at baseline were thinner (267 µm vs 299µm, p=0.03) with less eyes with baseline HE having sub-retinal fluid (23% vs 36%; p=0.008). Scars and geographic atrophy were distributed similarly in both groups at years 1 and 2. Among 129 eyes with HE at baseline, 25 eyes (21%) at 1 year and 6 (5%) eyes at 2 years had HE..

Conclusions : Hard exudates were more common in females and non-smokers. Eyes with HE had a thicker retina and larger lesions but exhibited a more rapid resolution of fluid than eyes without hard exudates. HE is not associated with visual acuity, development of scar, or geographic atrophy at 1 and 2 years.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Total retinal thickness

 

Change in total retinal thickness