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Jithin Yohannan, Barbara S. Hawkins, Jiangxia Wang, Sharon D Solomon; When and How Should Extrafoveal Choroidal Neovascular Lesions (EF-CNV) Be Treated? An Analysis of Data from the Macular Photocoagulation Study (MPS). Invest. Ophthalmol. Vis. Sci. 2016;57(12):2665.
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It is unknown whether certain patients with age-related macular degeneration (AMD) and EF-CNV: 1) lose best corrected visual acuity (BCVA) more slowly and may defer immediate treatment 2) can be treated sufficiently with laser photocoagulation (LP) without the need for alternate therapy (ie. Anti-VEGF agents). Therefore, we assessed the impact of baseline characteristics on the rate of vision loss in both untreated and laser treated eyes with AMD and EF-CNV.
We performed a secondary analysis of data from the MPS, a randomized trial assessing the impact of argon LP on BCVA in patients with AMD and EF-CNV. Baseline characteristics of eligible patients, study and fellow eyes were recorded. Eyes were examined every 6 months for 60 months and BCVA was recorded in ETDRS letters. Multilevel linear regression models were used to explore the rates of BCVA loss and predictors of BCVA loss separately for control eyes and treated eyes.
In the adjusted analysis, during the the initial 12 months of the study, untreated eyes (n=117) lost 8.30 letters of BCVA every 6 months (l6m). In these eyes, the presence of blood in the EF-CNV was associated with a decrease in rate of BCVA loss by 4.99 l6m (p=0.02). Treated eyes (n=119) lost 4.54 l6m in the first 12 months. In this group, blood was associated with a decrease in the rate of BCVA loss 5.22 l6m (p=0.01) and age greater than 70 was associated with an increase in the rate of BCVA loss by 2.53 l6m (p=0.01).Between months 12 and 60, the rate of BCVA loss slowed substantially to 0.70 l6m in untreated and 1.02 l6m in treated eyes. During this period, in treated eyes, male gender was associated with increase in the rate of BCVA loss by 2.35 l6m (p=0.02).
Untreated eyes with EF-CNV lost BCVA more slowly in the first 12 months if blood was present. However, even eyes with blood lost vision, which was most rapid in the first 12 months after enrollment. These data suggest that early treatment of EF-CNV lesions in untreated patients is critical.Laser treated eyes with EF-CNV and blood lost virtually no vision in the first 12 months. Therefore, laser may be a reasonable initial treatment option in eyes with blood. However, older and male patients tended to lose BCVA more rapidly after laser which suggests such patients may be better candidates for alternate therapy such as Anti-VEGF agents.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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