Chui Ming Gemmy Cheung1, Dilraj S Grewal2, Kelvin Yi Chong Teo3, Alfred Gan3, Aditi Mohla3, Usha Chakravarthy4, Tien Yin Wong5, Glenn J Jaffe2. 1. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Ophthalmology, National University of Singapore, Singapore, Republic of Singapore. Electronic address: gemmy.cheung.c.m@snec.com.sg. 2. Department of Ophthalmology, Duke University, Durham, North Carolina. 3. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore. 4. Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom. 5. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Ophthalmology, National University of Singapore, Singapore, Republic of Singapore.
Abstract
PURPOSE: To describe the rate of development and progression of fibrosis and macular atrophy (MA) and their relationship with 1-year visual outcomes in Asian participants with neovascular age-related macular degeneration (nAMD). DESIGN: Review of images collected from a prospectively recruited observational cohort. PARTICIPANTS: Participants with treatment-naïve nAMD. METHODS: All participants underwent multimodality imaging at baseline and month 12 and were treated according to standard of care. Retinal specialists evaluated color fundus photographs fluorescein and indocyanine green angiography images to determine the subtypes according polypoidal choroidal vasculopathy (PCV) and non-PCV subtypes. An independent reading center graded qualitative and quantitative morphologic features on spectral-domain OCT. Fibrosis and MA were determined based on multimodal imaging. MAIN OUTCOME MEASURES: Incidence of fibrosis and MA and their impact on visual outcome at 1 year. RESULTS: We included 93 eyes (48.4% PCV). Between baseline and month 12, visual acuity (VA) improved from 0.81±0.56 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, approximately 20/126) to 0.71±0.61 logMAR (Snellen equivalent, approximately 20/100; P = 0.007), and mean retinal thickness decreased from 471.1 μm to 343.4 μm (P < 0.001). Between baseline and month 12, prevalence of fibrosis and MA increased from 13.0% to 37.8% (P < 0.001) and 9.7% to 17.2% (P = 0.008), respectively. Worse baseline VA and presence of subretinal hyperreflective material (SHRM) at month 12 were associated with worse VA at month 12 after adjusting for multiple factors, whereas PCV subtype was associated with better VA at month 12. At month 12, the predominant composition of SHRM was fibrosis (82.5%). CONCLUSIONS: We describe significant development of fibrosis and MA in Asian nAMD eyes and show that fibrosis is the most important predictor of outcomes. These results highlight the need for therapy beyond anti-vascular endothelial growth factor inhibition to address fibrosis in Asian nAMD.
PURPOSE: To describe the rate of development and progression of fibrosis and macular atrophy (MA) and their relationship with 1-year visual outcomes in Asian participants with neovascular age-related macular degeneration (nAMD). DESIGN: Review of images collected from a prospectively recruited observational cohort. PARTICIPANTS: Participants with treatment-naïve nAMD. METHODS: All participants underwent multimodality imaging at baseline and month 12 and were treated according to standard of care. Retinal specialists evaluated color fundus photographs fluorescein and indocyanine green angiography images to determine the subtypes according polypoidal choroidal vasculopathy (PCV) and non-PCV subtypes. An independent reading center graded qualitative and quantitative morphologic features on spectral-domain OCT. Fibrosis and MA were determined based on multimodal imaging. MAIN OUTCOME MEASURES: Incidence of fibrosis and MA and their impact on visual outcome at 1 year. RESULTS: We included 93 eyes (48.4% PCV). Between baseline and month 12, visual acuity (VA) improved from 0.81±0.56 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, approximately 20/126) to 0.71±0.61 logMAR (Snellen equivalent, approximately 20/100; P = 0.007), and mean retinal thickness decreased from 471.1 μm to 343.4 μm (P < 0.001). Between baseline and month 12, prevalence of fibrosis and MA increased from 13.0% to 37.8% (P < 0.001) and 9.7% to 17.2% (P = 0.008), respectively. Worse baseline VA and presence of subretinal hyperreflective material (SHRM) at month 12 were associated with worse VA at month 12 after adjusting for multiple factors, whereas PCV subtype was associated with better VA at month 12. At month 12, the predominant composition of SHRM was fibrosis (82.5%). CONCLUSIONS: We describe significant development of fibrosis and MA in Asian nAMD eyes and show that fibrosis is the most important predictor of outcomes. These results highlight the need for therapy beyond anti-vascular endothelial growth factor inhibition to address fibrosis in Asian nAMD.
Authors: Philipp K Roberts; Markus Schranz; Alice Motschi; Sylvia Desissaire; Valentin Hacker; Michael Pircher; Stefan Sacu; Wolf Buehl; Christoph K Hitzenberger; Ursula M Schmidt-Erfurth Journal: Sci Rep Date: 2022-01-07 Impact factor: 4.379
Authors: Philipp Ken Roberts; Markus Schranz; Alice Motschi; Sylvia Desissaire; Valentin Hacker; Michael Pircher; Stefan Sacu; Wolf Buehl; Christoph Konrad Hitzenberger; Ursula Schmidt-Erfurth Journal: Transl Vis Sci Technol Date: 2021-12-01 Impact factor: 3.283