Changes in qCSF Contrast Sensitivity Following Anti-VEGF Injection in Exudative Age-Related Macular Degeneration

Abstract

Purpose : The purpose of our study is to evaluate changes in contrast sensitivity (CS) with the Quantitative CS Function (qCSF) test (Adaptive Sensory Technology), a robust CS evaluation that assesses visual function across multiple spatial frequencies, in nontreatment-naïve eyes with exudative age related macular degeneration (AMD) before and after intravitreal anti-VEGF injections.

Methods : This cross-sectional prospectively recruited observational study included 22 eyes of 14 patients with nontreatment-naive exudative AMD tested for CS with the qCSF test from July 2018 to July 2022. Functional outcomes included Snellen VA, and the following qCSF metrics: Area under the Log CSF (AULCSF), contrast acuity (CA), and CS thresholds at 1 to 18 cycles per degree (cpd). Paired T-tests were used to evaluate changes in visual function outcomes after injection. Statistical significance was set at p-value less than 0.05.

Results : In our AMD cohort, the median logMAR VA before intravitreal anti-VEGF injection was 0.239 (Snellen equivalent: 20/35) and after a single injection was improved at 0.226 (Snellen equivalent: 20/34), which was not statistically significantly different on pairwise comparison (p = 0.89). Among the CS metrics however, CS at 6 cpd was found to be statistically significantly improved after 1 intravitreal anti-VEGF injection (0.503 vs. 0.673, p = 0.007), while the other CS metrics were not significantly different. In a subset of 13 eyes of 11 patients with a decrease or no change in logMAR VA after 1 injection, CS at 6 cpd and AULSCF were able to still show statistically significant improvements, (0.584 vs. 0.676, p =0.033) and (0.710 vs. 0.714, p = 0.034) respectively.

Conclusions : Our results demonstrated that among eyes with nontreatment-naive exudative AMD, intravitreal anti-VEGF injection was associated with statistically significant improvements in contrast sensitivity, even when VA did not show a significant improvement. Across the various qCSF outcomes tested, CS at 6 cpd and AULCSF may be most sensitive to changes associated with intravitreal anti-VEGF injection which is consistent with prior published results. CS evaluation with the qCSF test is a useful adjunct functional metric that may impact the clinical decision making on whether to continue anti-VEGF injections among nontreatment-naïve eyes with AMD and other retinal diseases, even when VA has plateaued.

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