Association between central retinal thickness and low luminance visual acuity in early age-related macular degeneration

Purpose/Aim: To examine whether central retinal thickness (CRT) is related to mesopic visual acuity (VA) and low luminance deficit (LLD, difference between photopic and mesopic VA) in eyes with early and intermediate age-related macular degeneration (AMD). Materials and Methods: In a cross-sectional study, 50 pseudophakic subjects older than 63 years were divided into three groups (no AMD, early AMD and intermediate AMD). Spectral domain optical coherence tomography (SD-OCT) was used to measure CRT in the 1 mm-central-area. Best-corrected distance VA was measured under photopic or mesopic luminance conditions and LLD calculated. Subjects were stratified by VA impairment to compare CRTs across these groups. Relationships were examined by stepwise multiple linear regression. Results: No significant differences in mean CRT, photopic and mesopic VA or LLD were detected between the groups no AMD, early AMD and intermediate AMD. However, mean CRTs were 20 microns and 18 microns thicker in the eyes with impaired mesopic VA (> 0.3 logMAR) and impaired LLD (⩾ 0.3 logMAR) compared to the eyes with non-impaired VA or LLD respectively (both p < 0.01). CRT and mesopic pupil size were independent predictors of mesopic VA ( p = 0.001). CRT emerged as the only independent predictor of LLD ( p = 0.004). Conclusions: Increased CRT was linked to worse retinal function when measured under mesopic conditions in eyes without AMD and eyes with early to intermediate AMD. SD-OCT imaging combined with VA measurements under low luminance conditions could be a useful tool to detect early AMD.

Download Full-text

Predicting visual outcomes in patients treated with aflibercept for neovascular age-related macular degeneration: Data from a real-world clinical setting

European Journal of Ophthalmology ◽

10.1177/1120672119839299 ◽

2019 ◽

Vol 30 (3) ◽

pp. 543-549 ◽

Cited By ~ 2

Author(s):

Corinne Fulcher ◽

Charlotte A Hazel ◽

Ian Pacey ◽

Hasan Ali ◽

Faruque D Ghanchi

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Predictive Factor ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Response To Treatment ◽

Long Term Outcome ◽

Age Related

Background/objectives: There is a significant variation in the way neovascular age-related macular degeneration patients respond to anti–vascular endothelial growth factor treatment. Both the financial and time cost of treatment are significant. As such, being able to predict patient response to treatment is valuable. Subjects/methods: 72 eyes treated with intravitreal aflibercept were retrospectively included in analysis. For each subject, visual acuity (letters) and central retinal thickness (µm) at baseline, second, third and fourth visits, as well as 12-month visits, were collated; a plot of visual acuity versus time was generated and a slope of the first three (slope3) and first four (slope4) visits was calculated. Differences in visual acuity at each visit compared to baseline were determined, as well as percentage differences in central retinal thickness at each visit compared to baseline. Lesion sub-type and the presence of fluid and haemorrhage were also recorded. Results: The average change in visual acuity over 12 months was +3.2 ± 13.4 letters with 91.2% of patients losing <15 letters. Slope4 was the only significant predictive factor for ‘visual acuity change over 12 months’ ( p < 0.001). Change in central retinal thickness, lesion sub-type, haemorrhage at baseline and the location of fluid at baseline were not useful predictive factors in long-term outcome. Conclusion: Aflibercept is an effective treatment option for neovascular age-related macular degeneration; however, the long-term response should not be predicted until at least three loading dose injections have been given. Visual acuity measures at each visit should be examined, as it is the trend in visual acuity across the first four visits (slope4) rather than the difference in visual acuity between two visits that is the predictive factor.

Download Full-text

Percentage of Foveal vs Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degeneration

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419859454 ◽

2019 ◽

Vol 3 (5) ◽

pp. 278-282 ◽

Cited By ~ 4

Author(s):

Saghar Bagheri ◽

Ines Lains ◽

Rebecca F. Silverman ◽

Ivana Kim ◽

Dean Eliott ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Fundus Autofluorescence ◽

Cross Sectional Study ◽

Geographic Atrophy ◽

Age Related Macular Degeneration ◽

Cross Sectional ◽

Age Related ◽

The Impact ◽

Sd Oct

Purpose: This article investigates the relationship between visual acuity (VA), total area of geographic atrophy (GA), and percentage of foveal GA. Methods: A multicenter, retrospective, cross-sectional study was conducted of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT) images were collected. Using FAF images aided by SD-OCT, fovea-sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area—within a 1.5-mm-diameter circle centered on the fovea centralis—were assessed. Univariable and multiple linear regression analyses were performed. Results: Fifty-four eyes (mean age, 78.7 ±7.7 years [SD], 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logarithm of the minimum angle of resolution (Snellen equivalent 20/126 ± 20/80), mean total GA 8.8 ± 6.7 mm2, and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = .004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = .440). Conclusions: Percentage of foveal GA was significantly associated with VA impairment, although the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

Download Full-text

A comparative analysis of the course of wet age-related macular degeneration in eyes with incipient cataract and in eyes after phacoemulsification

Ophthalmology journal ◽

10.17816/ov2014427-32 ◽

2014 ◽

Vol 7 (4) ◽

pp. 27-32

Author(s):

Yuriy Sergeyevich Astakhov ◽

Nikita Yur’yevich Dal’ ◽

Natal’ya Viktorovna Chistyakova

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Retinal Thickness ◽

Treated Group ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Control Group ◽

Age Related ◽

Significant Difference ◽

Wet Amd

Many patients with wet age-related macular degeneration (AMD) also have a cataract in the same eye. Because there is a theoretical risk of progression of the degenerative processes in the macular area after surgical lens removal, this raises some ethical, clinical and economical questions for ophthalmologists. The purpose of the study was to compare the course of wet AMD in eyes with incipient cataract and the course in eyes after surgical cataract removal. Materials and methods: 135 eyes with wet AMD, 48 eyes - treated group - were subjects to phacoemulsification during the study, 87 eyes - control group - with incipient cataract without indications for surgery. Regular visits every 1.5 months during 2 years of follow-up with visual acuity testing, central retinal thickness analysis by optical coherence tomography (OCT). Anti-VEGF injections were performed according to a PRN regimen. Results: there was no statistically significant difference in visual acuity, central retinal thickness, intravitreal injection frequency between both groups during the study period. Conclusions: No influence of phacoemulsification on the wet AMD course was found.

Download Full-text

One-year Outcomes of a Treat-and-extend of Ranibizumab for Naive Exudative Age-related Macular Degeneration: Retrospective Analysis

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.7.939 ◽

2021 ◽

Vol 62 (7) ◽

pp. 939-947

Author(s):

Young-Je Choi ◽

Woong-Sun Yoo ◽

Yong-Wun Cho ◽

Yu-Jin Choi ◽

In Young Chung

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Treat And Extend ◽

Corrected Visual Acuity ◽

Age Related ◽

The Mean ◽

Treat And Extend Regimen

Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions: At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

Download Full-text

Intravitreal Aflibercept Outcomes in Patients with Persistent Macular Exudate Previously Treated with Bevacizumab and/or Ranibizumab for Neovascular Age-Related Macular Degeneration

Journal of Ophthalmology ◽

10.1155/2014/497178 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

David R. Griffin ◽

Preston P. Richmond ◽

John C. Olson

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Retinal Thickness ◽

Group Analysis ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Treatment Resistant ◽

Appreciable Change ◽

Age Related ◽

Intravitreal Aflibercept

Purpose. To assess whether intravitreal aflibercept (2.0 mg) can effectively reduce persistent macular exudate and enhance visual acuity in ranibizumab (0.5 mg) and/or bevacizumab (1.25 mg) treatment resistant patients with neovascular age-related macular degeneration.Methods. This retrospective study included 47 treatment resistant eyes from 47 patients switched to intravitreal aflibercept injections after receiving a minimum of 3 injections with either ranibizumab or bevacizumab. Snellen visual acuity and optical coherence tomography were assessed just prior to the first injection (baseline) and prior to the fourth injection (final). Additionally, anatomical regions of persistent macular exudate were tracked to determine if these areas yielded varying responses to aflibercept.Results. At baseline, patients had received an average of 11.3 injections with any prior anti-VEGF drug (SD 5.96). For whole group analysis, baseline and final central retinal thickness were 370.57 µm and 295.7 µm (P≤.001), respectively. Baseline and final retinal fluid volumes were 4.81 mm3and 4.37 mm3(P≤.001), respectively. Baseline and final logMAR were 0.56 and 0.53 (P=0.301), respectively. Anatomic location of persistent exudate did not appreciably alter treatment outcome.Conclusion. Central retinal thickness and total retinal fluid volume were reduced in ranibizumab and/or bevacizumab treatment resistant patients following three aflibercept injections. No appreciable change in visual acuity was noted.

Download Full-text

EXPERIENCE OF AFLIBERCEPT APPLICATION IN PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION

International Medical Journal ◽

10.37436/2308-5274-2019-4-19 ◽

2020 ◽

pp. 90-96

Author(s):

Darina Aleksandrovna Konovalova

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Macular Degeneration ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Intravitreal Injections ◽

Central Retinal Thickness ◽

Optical Coherence ◽

Treatment Results ◽

Age Related

Age−related macular degeneration is a threatening pathology, gradually leading to a complete loss of central vision, which adversely affects an individual physically and emotionally as well as socially, reducing the life quality of such patients. To analyze the anatomical and functional results of intravitreal injections of aflibercept in the patients with exudative age−related macular degeneration, 47 patients a were prospectively studied. Intravitreal injections of aflibercept were performed by the same surgeon under aseptic operating conditions at a dosage of 2 mg, which was 0.05 ml of the drug. All patients underwent a comprehensive ophthalmic examination, which included visometry, autoceratorefractometry, tonometry, biomicroscopy, and ophthalmoscopy under medical mydriasis, as well as optical coherence tomography. The study took place before the intravitreal administration of aflibercept, one month after each of the three loading injections, 4, 8, and 12 weeks, respectively, after the start of treatment, and 4 weeks after the fourth injection, which was performed 8 weeks after the third loading. The total follow−up period was 24 weeks. For assessing the anatomical and functional efficiency of the treatment the changes in visual acuity, which were adjusted as well as those in the central retinal thickness according to optical coherence tomography were accepted as the criteria. The treatment results showed a significant increase in visual acuity of patients with the most significant increase in the index at week 12 from the beginning of therapy, as well as to a statistically significant decrease in the central retinal thickness within six months of observation. It is obvious that a consistent use of this drug is necessary to achieve stable treatment results. Key words: exudative age−related macular degeneration, visual acuity, central retinal thickness, intravitreal antiangiogenic therapy.

Download Full-text

Switching Between Aflibercept and Ranibizumab in the Treatment of Refractory Exudative Age-related Macular Degeneration

OphthaTherapy Therapies in Ophthalmology ◽

10.24292/01.ot.270821 ◽

2021 ◽

Vol 8 (3) ◽

pp. 167-173

Author(s):

Małgorzata Wichrowska ◽

Jarosław Kocięcki ◽

Wojciech Suda

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Primary Therapy ◽

Corrected Visual Acuity ◽

Age Related ◽

Treatment Naïve ◽

Best Corrected Visual Acuity

Introduction: Aflibercept and ranibizumab have become the most used drugs in the treatment of wet age-related macular degeneration. Some patients; however, do not respond to aflibercept and ranibizumab treatment. Our aim was to determine whether the switch from aflibercept to ranibizumab, and then switchback, is effective in a group of patients poorly responding to aflibercept. We assessed best corrected visual acuity, central retinal thickness, and the presence of intra- and subretinal fluid (respectively). Material and methods: We conducted a retrospective comparative case series study. Twenty eyes of 20 patients, who had no inhibition of disease activity after at least one year of treatment with aflibercept, were included in the study. If after switch to ranibizumab the response to the drug was again inadequate, we returned to aflibercept. We divided the study population into two groups: treatment- naïve and patients who had received injections before entering the Drug Program for the Treatment of Age-Related Exudative Macular Degeneration. Results: We observed an improvement in both best corrected visual acuity and central retinal thickness parameters, but only in the treatment-naïve group. We did not observe any statistically credible effects for sub- and intraretinal fluid in the studied groups. Conclusions: Drug conversion may be beneficial for patients poorly responding to primary therapy. Greater improvement is seen in previously untreated patients.

Download Full-text

ASSOCIATION BETWEEN CENTRAL RETINAL THICKNESS AND VISUAL OUTCOME POST INTRAVITREAL RANIBIZUMAB INJECTION LOADING DOSES IN EXUDATIVE AGE RELATED MACULAR DEGENERATION

International Journal of Retina ◽

10.35479/ijretina.2021.vol004.iss002.169 ◽

2021 ◽

Vol 4 (2) ◽

pp. 169

Author(s):

Ferdian Ramadhan ◽

Ima Yustiarini ◽

Ady Dwi Prakosa ◽

Sauli Ari Widjaja ◽

Wimbo Sasono ◽

...

Keyword(s):

Macular Degeneration ◽

Retinal Thickness ◽

Visual Outcome ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Intravitreal Ranibizumab ◽

Cross Sectional ◽

Exudative Amd ◽

Age Related ◽

Before And After

Introduction : Age Related Macular Degeneration (AMD) stills the leading cause of blindness in developing countries for age 50 and above, increasing along higher life expectations.Anti- VEGF is the mainstay management for exudative AMD and able to reduce the central retinal thickness (CRT) and to increase the visual outcome. The aim of this study is to correlate between CRT and visual outcome in exudative AMD post intravitreal ranibizumab injection loading doses in Soetomo general academic hospital, Surabaya Methods : This was a retrospective, cross sectional study. Fourty two eyes who met inclusion criterias were received monthly loading doses of 0.5 mg Ranibizumab intravitreal injection for three consequtives months. Baseline visual acuity (BCVA) was measured with Snellen Chart converted to LogMAR, CRT was measured by SD-OCT. Parameters was measured before the first injection and after completed three months injections. Result : Fourty two eyes were composed by 59.5% male and 40.5% female with higher incidence in 61-70 years old (47.6%). Mean BCVA were 0.831 before and 0.624 after injection of serial Ranibizumab. Mean CRT were 346.9 and 254.2 µm before and after injection respectively. There was significant comparison between CRT and BCVA (p=0.00) & no correlation between CRT and BCVA before and after injection of Ranibizumab loading doses (p=0.418 & p=0.275) Conclusion : There were no correlation statistically between CRT and BCVA before and after injection of loading doses Ranibizumab intravitreal in exudative AMD. Further studies may be needed to prove the etiology of this tendencies.

Download Full-text

Our experience in visual functions' improvement in patiens with “wet” age-related macular degeneration at switching from one anti-VEGF agent to another

Ophthalmology journal ◽

10.17816/ov10367-73 ◽

2017 ◽

Vol 10 (3) ◽

pp. 67-73

Author(s):

Sergey A Korotkikh ◽

Evgeniy V Bobykin

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Choroidal Neovascularization ◽

Retinal Thickness ◽

Age Related Macular Degeneration ◽

Central Retinal Thickness ◽

Macular Volume ◽

Anti Vegf ◽

Age Related ◽

Previously Treated

Purpose. To assess mean changes in visual acuity, central retinal thickness and macular volume as well as to determine the duration of clinical choroidal neovascularization inactivity after single aflibercept injection in neovascular age-related macular degeneration (nAMD) patients switched from ranibizumab (preliminary date). Methods. Open-label prospective study. The study enrolled 23 patients with nAMD previously treated with ranibizumab. Results. Mean age of patients was 70.5 years, 16 were women. Mean number of ranibizumab injections given prior to switching to aflibercept was 8.7. After single aflibercept inravitreal injection mean visual acuity has significantly improved from 0.40 to 0.47 Snellen chart. Mean central retinal thickness has significantly reduced from 323.1 to 246.9 μm and mean macular volume has significantly reduced from 7.71 to 6.74 mm3. Duration of choroidal neovascularization (CNV) inactivity was 2.91 months. Conclusion. Single aflibercept intravitreal injection has resulted in significant visual gain as well as in significant central retinal thickness (CRT) and macular volume reduction. This provides evidence of aflibecept efficacy in nAMD patients previously treated with anti-VEGF. Duration of CNV inactivity provides clinical data supporting aflibercept injection every 8 weeks in nAMD patients. (For citation: Korotkikh SA, Bobykin EV. Our experience in visual functions' improvement in patiens with “wet” age-related macular degeneration at switching from one anti-VEGF agent to another. Ophthalmology Journal. 2017;10(3):67-73. doi: 10.17816/OV10367-73).

Download Full-text