Association Between Retinal Hemorrhage and Visual Acuity in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2)

Abstract

Purpose : The type of retinal hemorrhage (heme) in central and hemi-retinal vein occlusions (CRVO/HRVO) may serve as a biomarker of visual acuity. Our study investigated association between superficial heme (within nerve fiber layer (NFL)) and deep heme (below the NFL) and visual acuity letter score (VALS) in participants of the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2). We hypothesized that superficial heme is associated with worse visual acuity VALS both at baseline and at 6 months, following fixed monthly intravitreal anti-VEGF injections.

Methods : 304 eyes with gradable baseline CFP were graded to determine the proportion of superficial and deep heme within a 9 subfield grid (Figure). Field 9 was ungradable in >10% of eyes and not included in the analysis; Field 1 is over the optic nerve and was analyzed for peripapillary superficial heme (PSH) only. The predominant type of heme in each location was categorized as peripapillary superficial heme (PSH) in Field 1 - 5; macular superficial heme (MSH) and macular deep heme (MDH) in Fields 6 - 8. Predominance was assigned based on the highest proportion of heme in each location (superficial vs deep in all fields; PSH vs MSH vs MDH).

Results : Predominantly superficial compared to predominantly deep retinal hemorrhage at baseline was associated with worse VALS at baseline (48.9 vs 53.1; p = 0.03) but greater VALS at 6 months (71.1 vs 66.2; p = 0.029). When stratified for predominance based on location, there was no significant difference in baseline VALS between MSH, PSH and MDH (47.8, 49.5, and 53.1 respectively; p < 0.18). At 6 months, after adjusting for age, gender, race and ethnicity, subjects with MSH had higher VALS (69.8) than those with PSH (65.4) or MDH (65.2, p = 0.02). Subjects with MDH and MSH had greater increases in VALS from baseline to 6 months than subjects with PSH (20.7, 23.0, and 13.6 respectively; p < 0.001).

Conclusions : Superficial heme at baseline, specifically in the peripapillary location, has a worse VALS outcome in eyes with CRVO/HRVO. This suggests that assessment of type of heme in CRVO/HRVO may be a biomarker of VALS and peripapillary heme may correlate with worse VALS outcomes.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Example image of CFP with grid overlay shows the assessed fields. Fields 1-5 include the optic disc and peripapillary. Fields 6-8 include the periarcade and macula.