Principal Cause of Poor Visual Acuity after Neovascular Age-Related Macular Degeneration: Age-Related Eye Disease Study 2 Report Number 23.
Amitha Domalpally // Publications // Jan 01 2021
Author(s): Okeagu CU, Agrón E, Vitale S, Domalpally A, Chew EY, Keenan TDL; Age-Related Eye Disease Study 2 Research Group. Principal cause of poor visual acuity after neovascular age-related macular degeneration: Age-Related Eye Disease Study 2 Report Number 23. Ophthalmol Retina. 2021 Jan;5(1):23-31. doi: 10.1016/j.oret.2020.09.025. Epub 2020 Oct 10. PMID 33045457
Journal: Ophthalmology. Retina, Volume 5, Issue 1, Jan 2021
PURPOSE To analyze the principal cause for poor vision in eyes with best-corrected visual acuity (BCVA) of 20/200 or worse 2 years after neovascular age-related macular degeneration (nAMD).
DESIGN Prospective cohort study of participants enrolled in a clinical trial of oral supplements.
PARTICIPANTS Age-Related Eye Disease Study 2 (AREDS2) participants whose eyes began anti-vascular endothelial growth factor (VEGF) therapy for incident nAMD and had data available at 2 years.
METHODS Participants underwent refracted BCVA testing, ophthalmoscopic examination, and fundus photography at baseline and annual visits. Self-reports of anti-VEGF injections were collected.
MAIN OUTCOME MEASURES Principal cause of BCVA of 20/200 or worse at 2 years, detected on fundus photography grading.
RESULTS Of the 594 eligible eyes, the number with BCVA of 20/200 or worse at 2 years was 56 (9.4%). Mean BCVA was 14.9 letters (standard deviation [SD], 12.3 letters; Snellen equivalent, 20/500), versus 70.1 letters (SD, 12.8 letters; Snellen equivalent, 20/40) in the other group. Of the 55 eyes with fundus photography available at 2 years, 33 (60.0%) had central macular atrophy and 22 (40.0%) had central subretinal fibrosis assessed as the principal cause for poor vision. The group with poor BCVA had a higher proportion of non-White participants (8.9% vs. 1.7%; P = 0.006), lower BCVA 2 years earlier (mean, 38.0 letters [SD, 26.7 letters; Snellen equivalent, 20/160] vs. 71.8 letters (SD, 11.9 letters; Snellen equivalent, 20/40]; P < 0.0001), higher proportion with macular atrophy 2 years earlier (26.8% vs. 12.3%; P = 0.003), higher proportion with macular hemorrhage (25.5% vs. 13.2%; P = 0.014), and fewer anti-VEGF injections (7.6 vs. 10.2; P = 0.001).
CONCLUSIONS Visual acuity data and fundus photography were obtained in a clinical trial environment, but were related to anti-VEGF therapy given in routine clinical practice. At 2 years after starting anti-VEGF therapy, almost 1 in 10 eyes showed BCVA at the level of legal blindness. From fundus photography grading, the cause of poor vision appeared to be macular atrophy in 60% and subretinal fibrosis in 40%. These data may be useful in understanding the long-term limits to good vision in nAMD.
Published by Elsevier Inc.
Michael Altaweel, MD, Awarded McPherson ERI Monroe E. Trout Chair in Vision Research
Corpus Callosum Online Journal of the Arts Releases Second Edition