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Marion Schroeder, Monica Loevestam-Adrian; Vertical metamorphopsia improved in patients treated with Aflibercept for neovascular AMD at eighteen months follow-up.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2379.
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To evaluate the best-corrected visual acuity (VA), near vision acuity (NVA), metamorphopsia, quality of life (QoL) and central retinal thickness (CRT) in patients treated with Aflibercept for neovascular age-related macular degeneration (nAMD).
This prospective, randomized study included 28 eyes of 28 treatment-naïve patients (mean age 79 ±8 years) with nAMD. We examined VA, NVA, optical coherence tomography (OCT), and quantified metamorphopsia with M-CHARTS as horizontal metamorphopsia (MH) and vertical metamorphposia (MV) prior to intravitreal treatment with Aflibercept, at 6 and 18 months follow-up. We evaluated vision-related QoL with the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) before and 18 months after the first treatment.
M-CHARTS questionnaire score, the patients subjective metamorphopsia, significantly improved at 6 months (p=0.025) and at 18 months (p=0.019) compared to baseline. The M-CHARTS test showed a trend to decreased MV at 6 months (p=0.057) and a significant decrease at 18 months (p=0.002). At baseline 17.2% of the 28 patients experienced no degree (0°) of MV, 25% 0° MH, respectively. At 6 months 25% perceived 0° MV, 27.6% 0° MH; which still improved by 18 months with 37% 0° MV, and 44.8% 0° MH. NEI-VFQ-25 items that significantly improved were the composite score (p=0.015), general vision (p=0.003), near activities (p<0.001), mental health (p=0.01), and role difficulties (p=0.005).Confirming earlier studies neither M-CHARTS questionnaire nor test scores correlated with changes of VA or CRT. We showed significant improvement in mean VA from 65 ±13 to 71 ±16 letters (p=0.001) after 6 months, and 72 ±10 letters (p=0.004) at 18 months follow-up. CRT decreased from 300 ±80 μm to 220 ±37 μm (p<0.001) by 6 months, and was stable at 18 months with 218 ±35 μm (p<0.001). The decrease in OCT values correlated well with the improvement of VA and NVA at 6 months (r=-0.63; p<0.001 vs r=0.405; p=0.036), and 18 months (r=-0.778; p<0.001 vs r=0.525; p=0.007), respectively. Patients had received mean 4.7 ±0.5 injections after 6 months, and 10.9 ±1.9 after 18 months.
The subjective metamorphopsia score and MV had significantly decreased by 18 months. VA and NVA outcome correlated well with the decrease of CRT, but not with any M-CHARTS outcome. M-CHARTS scores could be considered an independent parameter.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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