Elsevier

Ophthalmology

Volume 120, Issue 9, September 2013, Pages 1860-1870
Ophthalmology

Original article
Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials

Presented in part at the Association for Research in Vision and Ophthalmology Meeting, May 6–10, 2012, Ft. Lauderdale, Florida; the Macula Society Meeting, June 11–15, 2012, Jerusalem, Israel; and the American Association of Retinal Specialists, August 25–29, 2012, Las Vegas, Nevada.
https://doi.org/10.1016/j.ophtha.2013.01.073Get rights and content

Objective

To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD).

Participants

Participants in the Comparison of Age-related Macular Degeneration Treatments Trials.

Methods

Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes.

Main Outcome Measures

Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA.

Results

Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120–212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features.

Conclusions

Anti–vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA. Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term significance is unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular AMD.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Study Population

Details of the design and methods for CATT have been published previously.3 Parameters used to determine the participants’ morphologic features at baseline and 52 weeks are summarized. A total of 1185 subjects were enrolled by 43 US clinical centers between February 2008 and December 2009. Only 1 eye per subject, the study eye, was treated as a part of the clinical trial. Inclusion criteria included subject age ≥50 years, presence of previously untreated active CNV secondary to AMD in the study

Presence and Type of Fluid on Optical Coherence Tomography Over Time

At baseline, all eligible eyes had at least 1 type of fluid, reflecting active CNV. The distribution of each fluid type at baseline was similar among the 4 treatment groups (Fig 1A–D). A high proportion of eyes had both SRF (83.8%) and IRF (76.7%). Sub-RPE fluid was present in approximately half (53.7%) of the eyes.

After anti-VEGF therapy, in all treatment groups, the proportion of eyes with fluid of any type (intraretinal, subretinal, or sub-RPE fluid) decreased markedly (Fig 1A). The largest

Discussion

In this study, several morphologic features determined on OCT, FA, and FP were significantly affected by intravitreal anti-VEGF therapy and had a significant relationship with VA. In particular, anti-VEGF treatment, regardless of drug and regimen, generally caused rapid and sustained reduction in macular fluid and thickness, stabilized lesion growth, reduced vascular leakage, and normalized retinal anatomy. Furthermore, presence of IRF, abnormally thin or thick retinas, larger CNV area, and

Cited by (231)

  • Towards a better understanding of non-exudative choroidal and macular neovascularization

    2023, Progress in Retinal and Eye Research
    Citation Excerpt :

    Sub-retinal hyperreflective material is characterized by the evidence of hyperreflective material in the subretinal space detected through OCT, which has been correlated with a poor visual outcome in neovascular AMD (Balaskas et al., 2019; Jaffe et al., 2013; Keane et al., 2008; Willoughby et al., 2015). Sub-RPE fluid develops in the context of RPE separation or detachment from the BrM and can also have prognostic significance like IRF and SRF (Chaudhary et al., 2021; Jaffe et al., 2013; Spaide et al., 2020). The CATT and HARBOR trials and other more recent studies have shown that sub-RPE fluid present at the final outcome visit correlates with a more favorable anatomic and visual outcome (Fang et al., 2021).

View all citing articles on Scopus

Manuscript no. 2012-1815.

Group members listed in Appendix 1 (available at http://aaojournal.org).

Financial Disclosure(s): The author(s) have made the following disclosure(s): G.J.J. has a consultancy relationship with Heidelberg Engineering and active or pending grants from Regeneron. C.A.T. has a consultancy relationship with Physical Sciences Inc.; active or pending grants from Genentech, Bioptigen, and Physical Sciences Inc.; a patent pending for OCT analysis technology related to analysis for AMD; and royalties from Alcon Laboratories for ophthalmic surgical technologies. G.J.J. and C.A.T.’s institution receives money for these relationships. The other members of the writing committee have no financial relationships to declare.

Supported by cooperative agreements U10 EY017823, U10 EY017825, U10 EY017826, and U10 EY017828 from the National Eye Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland. The funding organization participated in the design and conduct of the study and review of the manuscript.

ClinicalTrials.gov number NCT00593450.

The credit roster for the CATT Research Group is provided in Appendix 1, available at http://aaojournal.org.

View full text