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Justis P Ehlers, Leina Lunasco, Sari Yordi, Hasan Cetin, Kubra Sarici, Thuy K Le, Katherine E Talcott, Robert Zahid, Joanne Hu, Xiangyi Meng, Peter K Kaiser, Arshad M. Khanani, Sunil K Srivastava; The Impact of Compartmental Exudative Volatility on Visual Acuity Outcomes in Neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2022;63(7):366 – F0197.
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Greater volatility of retinal thickness during anti-VEGF therapy has been associated with poorer visual acuity outcomes in eyes with neovascular age-related macular degeneration (nAMD). This post hoc analysis of the HAWK study examined whether specific exudative compartmental volatility (e.g., intraretinal fluid [IRF], subretinal fluid [SRF], and subretinal hyperreflective material [SHRM]) was associated with visual outcomes.
The HAWK study was a randomized phase 3 study in patients with nAMD (NCT02307682). Six hundred fifty-two eyes in the brolucizumab 6 mg and aflibercept 2 mg arms were included in the post hoc analysis. IRF, SRF, and SHRM volume was measured using a machine-learning enhanced feature-extraction platform with manual correction, as needed. For each eye, the standard deviation (SD) of the volume of each exudative compartment (IRF, SRF, and SHRM) was calculated from Week 12 to Week 56 (i.e., following the initial loading phase and representing the visit-to-visit variability). For each exudative compartment, eyes with SDs ≤25th percentile and ≥75th percentile were considered to have low and high volatility, respectively. The effect of volatility on mean change in best corrected visual acuity (BCVA) was examined from Week 12 at Week 56.
Eyes with high SRF volatility demonstrated significantly worse visual outcomes compared to eyes with low SRF volatility (n=163, mean change=-2.18 letters vs n=314, mean change=+1.35 letters, respectively; P=0.0044). Similarly, eyes with high IRF volatility (n=163, mean change=-2.63 letters; P<0.0001) and eyes with low IRF volatility (n=367, mean change=+2.30 letters) had significant differences in change in visual acuity. Finally, there was also a significant difference in change in BCVA between eyes with high SHRM volatility (n=163, mean change=-2.47 letters; P=0.0001) and eyes with low SHRM volatility (n=166, mean change=+1.97 letters).
High volatility of each exudative parameter, including SRF, was associated with poorer visual outcomes. This suggests that identifying exudative fluctuation and potentially stabilizing that volatility may be important in maximizing visual acuity outcomes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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