Association between visual outcomes and macular fluid subtypes at initiation of anti-VEGF treatment for neovascular age-related macular degeneration - a real-world study

Abstract

Purpose : To describe the macular fluid characteristics of eyes at the time of presentation for anti-VEGF therapy for neovascular age-related macular degeneration (nAMD), and to relate these to visual acuity (VA) during the first two years of treatment.

Methods : This is a retrospective analysis of the VA and optical coherence tomography (OCT) characteristics of eyes throughout therapy with ranibizumab and/or aflibercept for nAMD in a single retina practice in Australia (January 2016 - November 2023). Volumetric analysis was undertaken with a machine learning algorithm for intraretinal (IRF) and subretinal fluid (SRF). Welch’s t-test and linear regression were used to analyze the relationship, after 1 and 2 years of treatment, between VA and the baseline presence and volume of IRF, SRF or both.

Results : 363 eyes were included in this study (mean 2.29 years of treatment; 20.86 injections/eye). At presentation, SRF and IRF alone were present in 43% and 18% of eyes, respectively; both in 39%.

Baseline VA in eyes with IRF-only or SRF-only were better than eyes that had both (p<0.001), with no significant difference in VA between eyes with IRF-only and SRF-only (P=0.32).

Mean VA was highest for baseline SRF-only compared to IRF-only at yr 1 (+5.83 letters [p<0.01]) and y r2 (+5.69 letters [p<0.001]) and eyes with both IRF and SRF (+15.88 letters [p<0.001] for yr 1, and +10.09 letters [p<0.001] for yr 2). Eyes with IRF-only at initiation lost the greatest amount of vision by year 2, followed by SRF-only and IRF and SRF (-8.97, -5.12 and -0.97 letters, respectively).

Baseline mean fluid volumes did not demonstrate a statistically significant relationship with VA at initiation, year 1 or year 2.

Conclusions : SRF was the most common fluid type at time of treatment initiation. Eyes presenting with only SRF had the best visual outcomes during the first two years, while eyes with both IRF + SRF had the worst. IRF-only had a similar VA at initiation to SRF-only, though had a greater decline in VA by year 2. Baseline fluid type, rather than volume, at time of treatment initiation may have greater prognostic value.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

At presentation, SRF and IRF alone were present in 43% and 18% of eyes. The mean volume of SRF was significantly more than IRF (p<0.001).

 

Baseline VA in eyes with IRF-only or SRF-only compared with eyes that had both IRF and SRF (p<0.001).