The Predictive Value of OCT Characteristics for the Visual Outcome in Neovascular AMD

Abstract

Background: The intravitreal injection of an anti-VEGF compound is the current standard of care in neovascular AMD. The response to this therapy varies greatly. To date it was not possible to determine clear predictive factors in regard to therapy response, thus making it difficult when counselling patients regarding the probability for visual improvement. The aim of this study was to evaluate baseline OCT characteristics in regard to their predictive value on the outcome of visual acuity (VA) after 12 months.

Patients and Methods: A retrospective analysis of 75 eyes with neovascular AMD treated with intravitreal anti-VEGF injections at the University Hospital of Zurich with a documented follow-up of at least 12 months. Measurement and comparison of the following OCT structures were undertaken: central retinal thickness (CRT), integrity of the IS/OS junction, and presence of intra- or subretinal fluid. VA at baseline and after 12 months was evaluated. OCT findings were compared between eyes that gained ≥ 5 letters ETDRS (group 1) and eyes that did not (group 2).

Results: 75 eyes with a mean baseline VA of 57.2 ± 15 letters and a mean baseline CRT of 430 ± 226 μm were analyzed. Although baseline VA did not differ statistically significantly, eyes in group 2 had a higher VA than eyes in group 1 (60.2 ± 16.2 vs. 54.9 ± 13.6, p = 0.123). In group 1 the change of VA after 12 months was 12.6 ± 8.0 letters while it was –5.0 ± 7.8 letters in group 2. No statistically significant differences between the two groups with respect to the analyzed OCT parameters were found. None of the analyzed OCT factors had a predictive value regarding the VA outcome at month 12.

Conclusions: Our study was not able to find baseline OCT parameters that could predict the course of VA after 12 months. However, eyes with a thicker central retinal thickness at presentation showed a greater reduction in CRT during the analyzed period. This was associated with a more favourable course in VA. Perhaps this might be due to a less pronounced initial morphological retinal damage.

Zusammenfassung

Hintergrund: Die intravitreale Injektion eines Anti-VEGF-Medikaments stellt momentan die Standardbehandlung bei neovaskulärer AMD dar. Die Visusverläufe variieren jedoch stark unter dieser Therapie und bis heute konnten keine prädiktiven Faktoren für das Ansprechen eruiert werden, was eine Beratung des Patienten hinsichtlich des Therapieverlaufs erschwert. Ziel dieser Studie war es, Charakteristiken der OCT-Untersuchung bei der Erstvorstellung im Hinblick auf ihren prädiktiven Wert auf den Visusverlauf nach 12 Monaten zu evaluieren.

Patienten und Methoden: Retrospektive Analyse von 75 Augen mit neovaskulärer AMD, welche am Universitätsspital Zürich mit intravitrealen Anti-VEGF-Injektionen behandelt wurden und einen dokumentierten Untersuchungsverlauf von mindestens 12 Monaten hatten. Messung und Vergleich folgender OCT-Parameter: zentrale Retinadicke (CRT), Intaktheit der IS/OS-Linie, Vorhandensein von intra- und subretinaler Flüssigkeit. Die Messresultate wurden zwischen Augen mit einer Visusverbesserung ≥ 5 Buchstaben ETDRS (Gruppe 1) nach 12 Monaten und denen, die dies nicht erreichten (Gruppe 2), verglichen.

Ergebnisse: 75 Augen mit einem durchschnittlichen Ausgangsvisus von 57,2 ± 15 Buchstaben und einer mittleren zentralen Retinadicke von 430 ± 226 μm wurden analysiert. Augen in Gruppe 2 hatten einen statistisch nicht signifikanten besseren Ausgangsvisus als Augen in Gruppe 1 (60,2 ± 16,2 vs. 54,9 ± 13,6, p = 0,123). In Gruppe 1 betrug der durchschnittliche Visusgewinn nach 12 Monaten 12,6 ± 8,0 Buchstaben, während in Gruppe 2 ein durchschnittlicher Visusverlust von –5,0 ± 7,8 Buchstaben zu beobachten war. Bezüglich der analysierten OCT-Parameter konnten keine statistisch signifikanten Unterschiede gefunden werden. Ausgehend von den analysierten Daten konnten keine prädiktiven Werte für den Visusverlauf nach 12 Monaten eruiert werden.

Schlussfolgerung: In unserer Studie zeigte keiner der gemessenen Faktoren einen prädiktiven Wert für den Visusverlauf nach 12 Monaten. Eine dickere zentrale Retinadicke bei Erstvorstellung wies eine durchschnittlich größere Reduktion der zentralen Retinadicke auf. Dies war assoziiert mit einem besseren Visusverlauf. Möglicherweise ist dies durch einen geringeren initialen morphologischen Schaden der Retina bedingt.

Key words

neovascular AMD - optical coherence tomography - prognostic factors - OCT characteristics

Schlüsselwörter

neovaskuläre AMD - optische Kohärenztomografie - prognostische Faktoren - OCT-Charakteristiken

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