Abstract

Purpose: To report a new stratified approach to predict visual acuity outcome after anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration (AMD) using Spectral-Domain Optical Coherence Tomography. Methods: We reviewed a consecutive series of 70 patients after three monthly intravitreal ranibizumab treatments for primary neovascular AMD. Age, sex, baseline vision, choroidal neovascularization type as well as OCT characteristics were correlated to final vision. On OCT, baseline integrity of the fovea was studied using foveal thickness (FTH), external limiting membrane (ELM) and ellipsoid zone as hallmarks. Masked readers graded images. Multivariate analyses and stepwise regressions were performed to correlate baseline characteristics with vision at 3 months. Results: Baseline vision (p-value = 0.0001) and ELM (p-value = 0.033) were the only significant independent predictors of final vision. However, a regression model stratifying baseline vision according to the status of pretreatment ELM turned out to best predict the variance in vision at month 3 (R2 = 0.87, 0.75, 0.68 for absent, disturbed and present ELM, respectively). Conclusion: Improved prognostic information can be obtained by using the pretreatment ELM as a stratifying biomarker of baseline vision. A reliable prognosis could be of great value to guide the therapeutic approach especially in patients that are unlikely to benefit from the treatment and are not supported by a health care insurance.

Authors and Affiliations