Relationship between Intraretinal and Subretinal Fluid with Visual Acuity in Patients with Neovascular Age-Related macular Degeneration Treated with Anti-Vascular Endothelial Growth Factor

Abstract

Purpose : Anti-vascular endothelial growth factor (VEGF) treatment is used to treat neovascular age-related macular degeneration (nAMD). Fluid resolution by OCT is used both as an indicator of disease control and to guide the frequency of treatment since anti-VEGF therapy reduces neovascularization-related exudation. The variability in treatment response is considered a poor prognosis for visual acuity (VA). This study seeks to characterize the specific fluid compartment drives this variability. The hypothesis is that there will be poorer VA outcomes for eyes in the highest quartile of IRF volumes and no significant correlation between SRF and VA.

Methods : A retrospective cohort study of 301 treatment-naïve nAMD eyes was performed at the Cleveland Clinic Cole Eye Institute. Spectral domain optical coherence tomography (OCT) scans were obtained for patients over a 12 month period at 3 month intervals from January 1^st, 2012 to October, 31^st, 2019. Patients were excluded if they had maculopathies unrelated to nAMD that would interfere with analysis. IRF and SRF quantification was performed by the Notal Optical Coherence Tomography Analyzer (NOA), which employs machine learning and image recognition computational techniques. Baseline demographics and VA were also recorded at each visit. A linear mixed-effects regression model (LMER) was used to analyze the effect of IRF and SRF on VA over 12 months by quartiles.

Results : Mean IRF was 122.23±270.14mm³ (mean ±SD) at baseline and 24.39±106.56 mm³ at 12 months (p<0.001). Mean SRF at baseline was 215.52±394.86 mm³ and 64.42±173.70 mm³ at 12 months (p<0.001). Mean number of injections was 8.25±2.47. Mean VA at baseline was 60.13±18.79 ETDRS letters and 65.68±17.19 ETDRS letters at 12 months (p<0.001). The LMER showed that eyes in the highest quartile of IRF volume had a significant VA loss of -4.26±2.54 ETDRS letters compared to those not in this quartile (p=0.001) after adjusting for baseline factors and injections. There was no significant relationship between SRF and VA.

Conclusions : High levels and high variability of IRF volume are associated with poorer VA outcomes in patients with nAMD treated with anti-VEGF. Further studies can provide insight into treatment patterns in nAMD patients with IRF and SRF and how that relates to VA.

This is a 2021 ARVO Annual Meeting abstract.