Abstract
Purpose :
There is limited literature available on patients with neovascular age-related macular degeneration (nAMD) presenting with best-corrected visual acuity (BCVA) better than 20/40. We aimed to characterize the OCT findings in eyes with nAMD and BCVA >20/40 at baseline and 3-year follow-up during anti-vascular endothelial growth factor (anti-VEGF) monotherapy.
Methods :
Retrospective analysis of patients with a diagnosis of nAMD and BCVA >20/40 from a single tertiary medical center. OCT images were analyzed at baseline and every 6 months for a period of 3 years with extrapolation of findings such as subretinal fluid (SRF), intraretinal fluid (IRF), choroidal neovascularization (CNV) characteristics, central macular thickness (CMT), and subfoveal choroidal thickness (SCT). Multivariate logistic regression was used to analyze associations between OCT parameters and visual prognosis.
Results :
A total of 57 eyes from 54 patients were included in this study with 294 OCT visits analyzed. Mean logMAR changed from 0.12±0.07 at baseline (20/25 Snellen VA) to 0.35±0.15 (20/45) at year 3 (p<0.05), with only 21.1% of eyes losing 3 or more Snellen lines during anti-VEGF monotherapy. Mean number of injections over 3 years was 4.94±3.64. By year 3, 31 eyes had SRF (54.4%), 16 IRF (28.1%), and 13 had both (22.8%) compared to 73.7%, 36.8%, and 28.1% at baseline, respectively. CNV location at baseline was 40 subfoveal (70.1%), 12 juxtafoveal (21.1%), and 5 extrafoveal (8.7%). Over 3 years, 22 eyes (38.6%) had expanded location of CNV. CNV type was 31 type 1 (54.4%) and 26 mixed type (45.6%). Mean CMT was 277.5±38.6 at baseline and 257.92±38.19 at 3 years (p<0.05). Mean CNV length at baseline was 1034.37±467.35 and 1368.88±776.48 at 3 years (p<0.05). Mean SCT at baseline was 166.34±53.63 and 175.66±69.35 in year 3 (p=0.48). In multivariate logistic regression, a larger CMT at baseline was associated with worsened BCVA at 3-year follow-up (p<0.05). Increases in CMT from baseline correlated with maintained or improved BCVA at 3-year follow-up (p<0.05).
Conclusions :
OCT analysis of this unique nAMD subgroup with baseline VA >20/40 showcased CNV Type 1 as the most common presentation with expanded CNV in 1/3 of eyes despite receiving anti-VEGF therapy. Increased CMT from baseline to 3-year follow-up was correlated with maintained or improved BCVA (p<0.05).
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.