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Jason Hsu, Ehsan Rahimy, Gui-Shuang Ying, Wei Pan; Effect of Intraocular Pressure (IOP)-Lowering Medications on Neovascular Age-Related Macular Degeneration (AMD) Treatment Outcomes in the Comparison of AMD Treatment Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2017;58(8):1197. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
A pilot study recently suggested that topical aqueous suppressants may decrease macular edema in neovascular AMD eyes with persistent exudation despite anti-vascular endothelial growth factor (VEGF) therapy. We performed a secondary analysis of the CATT data, evaluating the effect of IOP-lowering medications on outcomes.
Medication logs were reviewed for continuous 2-year use of agents that increased aqueous outflow (Group A: topical prostaglandins) or suppressed aqueous production (Group B: topical beta blockers, carbonic anhydrase inhibitors). Eyes were excluded if any mixed-mechanism IOP-lowering agents were used or if medications from more than one group of drug were taken. Treatment responses at year 2 in each group were compared to all controls (no IOP-lowering medications). Group B patients were also compared to 1:1 matched controls.
Analysis included 28 Group A patients, 19 Group B patients, and 857 controls. After 2 years, the control group had a mean visual acuity (VA) gain of +6.3 letters from baseline, compared to +3.5 letters in Group A (P=0.38), and +13.8 letters in Group B (P=0.052). Mean retinal thickness change from baseline was -50 μm in the control group, -72 μm in Group A (P=0.37), and -106 μm in Group B (P=0.047). Mean total thickness change from baseline was -160 μm in the control group, -189 μm in Group A (P=0.46), and -251 μm in Group B (P=0.04). When Group B was 1:1 matched to controls, mean VA change was +13.8 letters in Group B vs. +1.9 letters in matched controls (P=0.04), mean retinal thickness change was -106 μm vs. -44 μm (P=0.33), and mean total thickness change was -251 μm vs. -228 μm (P=0.38).
Concurrent use of aqueous suppressants during intravitreal anti-VEGF treatment for neovascular AMD was associated with greater reductions in retinal thickness and total thickness as well as improved visual outcomes after 2 years. A similar effect was not observed with agents that reduce IOP by increasing aqueous outflow. Due to the small sample size and secondary analysis, these findings must be interpreted with caution and perhaps serve as a basis for future prospective studies.
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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