Laird Harrison

September 18, 2015

 

NICE, France — In patients with neovascular age-related macular degeneration, pigment epithelial detachment and intraretinal cysts are more important biomarkers of vision loss than subretinal fluid, researchers report.

This information will be useful when determining which patients need to be followed most closely, said Hrvoje Bogunović, PhD, from the Christian Doppler Laboratory for Ophthalmic Image Analysis at the Medical University of Vienna.

"It all comes down to the need to optimize the treatment," he told Medscape Medical News. The current standard measure of neovascular age-related macular degeneration — central foveal thickness — is only loosely correlated to visual function.

Dr Bogunović presented the finding here at the European Society of Retina Specialists 15th EURETINA Congress.

Moving Beyond Central Foveal Thickness

In their study, Dr Bogunović and his colleagues used 3-dimensional optical coherence tomography to analyze retinal layers.

Some of the team's findings where they use this approach to analyze data from the VIEW trial have already been published (Ophthalmology. 2015;122:822-832).

The researchers found a correlation between worse visual acuity and the presence of cystoid fluid at baseline or after 12 weeks of intravitreal antiangiogenic therapy.

The existence of subretinal fluid at 12 weeks was associated with worse visual acuity, but the reduction in visual acuity was less than with cystoid fluid.

At 2 years, patients with pigment epithelial detachment fared worse than those with cysts and no detachment, but patients with both detachment and cysts had the poorest outcomes.

"The idea is that pigment epithelial detachment is causing reactivation of the age-related macular degeneration," Dr Bogunović explained. "These patients need to be followed carefully."

In contrast, there was a correlation between improved visual acuity and the presence of subretinal fluid at 12 weeks.

Dr Bogunović and his team also analyzed the volume of the three types of exudate in a subset of treatment-naïve patients. They found correlations between decreased visual acuity and intraretinal cystoid fluid volume, but no significant correlation between subretinal fluid volume and visual acuity.

"The correlation is not strong, but the message is clear: it's the volume of the cystoid fluid that is associated with poorer vision," he said.

The researchers have since developed computerized algorithms to quickly analyze these patterns, with the goal of sorting patients into mild and progressive disease subgroups.

They plan to analyze patterns of anatomic features occurring over time, locations of edema, and the appearance of hyperreflective foci.

These findings are "quite illuminating," said session moderator Paul Mitchell, MD, from the University of Sydney in Australia. "I think it's going to be quite influential in predicting which patients are going to do well, not so well, or very well," he told Medscape Medical News.

Dr Bogunović has disclosed no relevant financial relationships. Dr Mitchell reports financial relationships with Novartis, Bayer, Allergan, Alcon, and Roche.

European Society of Retina Specialists 15th EURETINA Congress. Presented September 17, 2015.

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