OCT Biomarkers Associated with Reading Performance in Patients with Neovascular Age-Related Macular Degeneration and Good Visual Acuity

Abstract

Purpose : Even in presence of a good distance visual acuity, patients with neovascular age-related macular degeneration (AMD) may complain of near vision impairment and reduced reading ability with a significant impact on their quality of life. The aim of this study was to evaluate reading performance metrics in neovascular AMD patients with high values of distance visual acuity and to investigate their association with retinal structural biomarkers

Methods : We prospectively enrolled 90 patients with previously-treated exudative neovascular AMD and best-corrected visual acuity (BCVA) ≤ 0.3 LogMAR. The reading acuity score (RA score) and maximal reading speed (max RS) metrics were tested using the Radner Reading Chart (RRC). Two experienced readers graded different optical coherence tomography (OCT) findings associated with exudative neovascular AMD within each Early Treatment Diabetic Retinopathy Study (ETDRS) subfield. A regularized linear model with the least absolute shrinkage and selection operator (LASSO) was used to evaluate the association of these biomarkers with reading performance metrics.

Results : A total of 90 eyes from 90 patients were included in this study (median [IQR] age 81.0 [75.0-84.0] years; median [IQR] BCVA, 0.1 [0.05-0.22] LogMAR). Reading performance was characterized by a median (IQR) monocular RA score of 0.54 (0.42-0.63) logarithm of the reading acuity determination (LogRAD) and a mean (±SD) monocular max RS of 137.6 (±47.3) words per minute (wpm).
In the multivariable cross-sectional analysis, syllables mispronounced or unread, ellipsoid zone disruption in the outer lower ETDRS subfield, external limiting membrane disruption in the central ETDRS subfield, age, and BCVA showed an association with RA score (cross-validated R² for RA score of 0.23). Variables that showed an association with max RS were ellipsoid zone disruption in the inner lower ETDRS subfield, RPE loss in the inner left ETDRS subfield, external limiting membrane disruption in the inner left ETDRS subfield, age, and BCVA (cross-validated R² for max RS of 0.23)

Conclusions : OCT biomarkers reflecting outer retinal damage are associated with worse reading performance in patients with neovascular AMD and good visual acuity. Our findings may suggest that metrics reflecting the reading performance may be considered as novel relevant functional endpoints in clinical trials

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.