July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Reductions in primary visual cortex volume in patients receiving long-term treatment for neovascular age-related macular degeneration.
Author Affiliations & Notes
  • Rachel Woodall
    Department of Psychology, University of York, York, United Kingdom
    York Neuroimaging Centre, York, United Kingdom
  • Richard P. Gale
    Academic Unit of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom
    Department of Health Sciences, University of York, York, United Kingdom
  • Andre Gouws
    York Neuroimaging Centre, York, United Kingdom
  • Martin Scott
    Department of Psychology, University of York, York, United Kingdom
    York Neuroimaging Centre, York, United Kingdom
  • Edward Silson
    Department of Psychology, University of York, York, United Kingdom
  • Kerry Bell
    Department of Psychology, University of York, York, United Kingdom
  • Mason Wells
    Department of Psychology, University of York, York, United Kingdom
  • Aaron Wright
    Department of Psychology, University of York, York, United Kingdom
  • Sophie Waterson
    Department of Psychology, University of York, York, United Kingdom
  • Farah Akthar
    Department of Psychology, University of York, York, United Kingdom
  • Heidi Baseler
    Department of Psychology, University of York, York, United Kingdom
    Hull York Medical School, University of York, York, United Kingdom
  • Antony Morland
    Department of Psychology, University of York, York, United Kingdom
    York Neuroimaging Centre, York, United Kingdom
  • Footnotes
    Commercial Relationships   Rachel Woodall, ESRC (F); Richard P. Gale, None; Andre Gouws, None; Martin Scott, None; Edward Silson, None; Kerry Bell, None; Mason Wells, None; Aaron Wright, None; Sophie Waterson, None; Farah Akthar, None; Heidi Baseler, None; Antony Morland, Fight for Sight (F)
  • Footnotes
    Support  ESRC WR DTC +3 Scholarship
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 5021. doi:https://doi.org/
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      Rachel Woodall, Richard P. Gale, Andre Gouws, Martin Scott, Edward Silson, Kerry Bell, Mason Wells, Aaron Wright, Sophie Waterson, Farah Akthar, Heidi Baseler, Antony Morland; Reductions in primary visual cortex volume in patients receiving long-term treatment for neovascular age-related macular degeneration.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5021. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Anti-angiogenic treatment for neovascular age-related macular degeneration (nvAMD) aims to preserve vision. However, despite initial mean gains recovering around 50% of lost vision, visual acuity (VA) often slowly declines over several years. Neuroimaging studies have shown structural reductions of visual cortex volume and grey matter in long-term vision deprivation, if left untreated. This study assessed whether structural changes also occur in primary visual cortex (V1) despite long-term anti-angiogenic treatment for nvAMD.

Methods : Measurements of visual cortical structure, VA (ETDRS score) and 1mm3 subfield central retinal thickness (CRT) measured with spectral domain optical coherence tomography, were performed in 7 nvAMD patients undergoing standard care anti-vascular endothelial growth factor treatment. Assessments took place before treatment commenced, after the treatment initiation phase (1-4 months) and after several years (3.6-5.9 years). T1-weighted magnetic resonance imaging (MRI) measured cortical changes in 3 regions of interest: the entire occipital cortex, V1 representing the affected macula (occipital pole, OP) and peripheral, unaffected retina (calcarine sulcus, CS).

Results : A significant volumetric decrease was found in the entire occipital cortex after long-term treatment (31767 to 28639mm3, p=0.023), primarily due to reduced cortical thickness of the OP (2.11 to 1.94mm, p=0.027) rather than the CS (1.83 to 1.76mm, p=0.174). A linear regression revealed that changes in the entire brain (excluding the occipital lobes) largely explained variance observed in the CS (65%, p=0.029) but did not fully account for reductions in the OP (31.6%, p=0.189). Clinical assessments revealed increased VA during treatment initiation, decreasing slightly with long-term treatment (57, 68, 63 ETDRS, n.s). CRT initially decreased, with signs of stabilisation following long-term treatment (356.2, 263.7, 252.1µm, n.s).

Conclusions : VA improvements following treatment were maintained above pre-treatment levels over the long term, while CRT showed stabilisation. Nevertheless, long-term anti-angiogenic treatment did not prevent significant atrophy of V1 in representations of the retinal regions affected in nvAMD. This study provides a hypothesis about the potential role of visual cortex in long-term vision loss in patients treated for nvAMD.

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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