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Daniel F Martin, Stuart L Fine, Wei Pan, Juan E Grunwald, Ebenezer Daniel, Glenn J Jaffe, Cynthia A Toth, Gui-Shuang Ying, Maureen G Maguire; Characteristics of Patients with Good Visual Acuity at 5 Years Despite No Treatment after 2 Years in the Comparison of AMD Treatment Trials (CATT) Follow-up Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1196. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe characteristics of patients with neovascular age-related macular degeneration (AMD) initially treated with ranibizumab or bevacizumab who had good visual acuity (VA) at 5 years but with no treatment after 2 years.
CATT participants were randomly assigned to receive ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After two years, patients were released from the clinical trial protocol and were recalled for examination at 5 years. At baseline, through 2 years, and at 5 years, certified examiners tested VA and masked readers evaluated fundus morphology on color photographs & fluorescein angiography and fluid in & thickness of the retina on optical coherence tomography (OCT). We identified a subset of eyes that received no treatment after Year 2 and had VA 20/40 or better at Year 5 – the Good VA-NoRx group.
Among 647 patients with VA measured at 5 years, 46 (7.1%) were in the Good VA-NoRx group (median 20/25). The median number of visits between 2 and 5 years was 11 (interquartile range: 8 to 17) and the median change in VA from Year 2 was -2 letters (- 6 to 1). Compared to other eyes at 5 years, Good VA-NoRx eyes at 5 years had smaller lesion area (median 5.4 vs 9.9 mm2; p=0.001), were more likely to have no apparent lesion (photographs) in the foveal center (34% vs 17%; p=0.01), were more likely to have no fluorescein leakage (90% vs 74%; p=0.05), were more likely to have no fluid on OCT (38% vs 15%), and had greater retinal thickness (median 158 vs 134µ; p=0.001). On univariate analysis, factors at baseline associated with greater probability of being in the Good VA-NoRx at 5 years included younger age, better VA in the study eye, blocked fluorescence associated with the CNV lesion, absence of late AMD in the fellow eye, and no RPE elevation on OCT. At 3 months after initiation of treatment, the mean change in the Good VA-NoRx group was +8.9 letters compared to +6.3 letters in other eyes (p=0.12).
A small percentage of eyes initially treated with anti-VEGF therapy can maintain good visual acuity without long-term treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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