A prospective study of treatment patterns and 1-year outcome of Asian age-related macular degeneration and polypoidal choroidal vasculopathy.

OBJECTIVE: To study the treatment patterns and visual outcome over one year in Asian patients with choroidal neovascular membrane secondary to age-related macular degeneration (AMD-CNV) and polypoidal choroidal vasculopathy (PCV). DESIGN: Prospective cohort, non-interventional study. METHODS: 132 treatment-naïve patients who received treatment for AMD-CNV and PCV were included. All patients underwent standardized examination procedures including retinal imaging at baseline and follow-up. AMD-CNV and PCV were defined on fundus fluorescein angiography and indocyanine green angiography at baseline. Patients were treated according to standard of care.We report the visual acuity (VA) and optical coherence tomography (OCT) measurements at baseline, month 3 and month 12 The factors influencing month 12 outcomes were analyzed. MAIN OUTCOME MEASURE: Type of treatment, number of Anti-vascular endothelial growth factor (VEGF) treatments, visual outcome over one year. RESULTS: Anti-VEGF monotherapy was the initial treatment in 89.1% of AMD-CNV, but only 15.1% of PCV. The mean number of anti-VEGF injections up to month 12 was 3.97 (4.51 AMD-CNV, 3.43 PCV, p = 0.021). Baseline OCT, month 3 OCT and month 3 VA were significant in determining continuation of treatment after month 3. At month 12, mean VA improved from 0.82 (∼20/132) at baseline to 0.68 (∼20/96) at month 12 (mean gain 6.5 ETDRS letters, p = 0.002). 34.2% of eyes (38/113 eyes) gained ≥15 ETDRS letters and 14.4% (16/113 eyes) lost ≥15 ETDRS letters. There were no significant differences in visual outcome between AMD-CNV and PCV (p = 0.51). Factors predictive of month 12 visual outcome were baseline VA, baseline OCT central macular thickness, month 3 VA and age. CONCLUSIONS: There is significant variation in treatment patterns in Asian eyes with exudative maculopathy. There is significant visual improvement in all treatment groups at one year. These data highlight the need for high quality clinical trial data to provide evidence-based management of Asian AMD

Retinal neural dysfunction in diabetes revealed with handheld chromatic pupillometry

10.1111/ceo.14116CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY507745-75

Choroidal remodeling in age-related macular degeneration and polypoidal choroidal vasculopathy : a 12-month prospective study

Choroid thinning occurs in age-related macular degeneration (AMD). However, it remains unclear whether the reduction is due to reduction in choroidal vessels or shrinkage of choroidal stroma, or both. The purpose of this study was to evaluate the changes of the choroidal vascular and stromal area in 118 patients with typical AMD (t-AMD) and polypoidal choroidal vasculopathy (PCV) over a 12-month period. We used spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI) mode to measure the subfoveal choroidal thickness (CT), central retinal thickness (CRT) and choroidal vascularity index (CVI - ratio of luminal area to total choroidal area). At baseline, PCV eyes had higher CRT (471.6 µm vs 439.1 µm, p = 0.02), but comparable subfoveal CT and CVI, compared to t-AMD. Eyes with high CVI at baseline showed marked reduction in stromal area compared with eyes with average or low CVI. Over 12 months, CRT and subfoveal CT significantly decreased (p < 0.001) in both subtypes. Eyes with high baseline CVI showed significant CVI reduction from baseline to month 12 (p < 0.001), whereas eyes with average to low baseline CVI showed increase in CVI. These differences in choroidal vascularity may reflect different predominant pathogenic processes and remodeling in AMD eyes with varying spectrum.Published versio

Initial Treatment Pattern from Baseline to Month 3, comparing eyes with Age-related Macular Degeneration (AMD-CNV) and Polypoidal Choroidal Vasculopathy (PCV).

<p>* Treatment given before month 3 (inclusive).</p>†<p>P value to test the distribution of initial treatment between AMD and PCV, Fisher's exact test.</p><p>AMD-age-related macular degeneration, PCV- polypoidal choroidal vasculopathy, anti-VEGF- anti-vascular endothelial growth factor, PDT-photodynamic therapy.</p

Baseline Characteristics, comparing eyes with Age-related Macular Degeneration (AMD-CNV) and Polypoidal Choroidal Vasculopathy (PCV).

<p>*Indicating whether a scar was present in the fellow eye.</p>†<p>Exclude statistically outlier values of 18, 23, 785.</p><p>AMD-age-related macular degeneration, PCV- polypoidal choroidal vasculopathy, OCT- optical coherence tomography; CMT - central macular thickness.</p

Distribution of Initial Treatment Modalities by diagnosis of Age-related Macular Degeneration (AMD-CNV) (left) and Polypoidal Choroidal Vasculopathy (PCV) (right).

<p>Distribution of Initial Treatment Modalities by diagnosis of Age-related Macular Degeneration (AMD-CNV) (left) and Polypoidal Choroidal Vasculopathy (PCV) (right).</p

Comparison of Patient Characteristics and Anti-VEGF Utilization during the First Year of Treatment.

<p>Formula of conversion from LogMAR to ETDRS letters: 85-50LogMAR.</p><p>AMD - age-related macular degeneration; PCV- polypoidal choroidal vasculopathy; SD standard deviation.</p

Mean visual acuity of all treated eyes from baseline to month 12.

<p>The number of eyes with OCT available at each timepoint is indicated by n.VA Visual acuity; SE standard error.</p

Cumulative number of Anti-vascular endothelial growth factor (anti-VEGF) injections and follow-up visits to month 12, comparing eyes with Age-related Macular Degeneration (AMD-CNV) and Polypoidal Choroidal Vasculopathy (PCV).

<p>*P value based on Wilcoxon rank sum test.</p><p>AMD-age-related macular degeneration, PCV- polypoidal choroidal vasculopathy, anti-VEGF- anti-vascular endothelial growth factor, PDT-photodynamic therapy.</p

Visual Acuity and Optical Coherence Tomography Central Macular Thickness at Month 3 and Month 12, stratified by Diagnosis.

<p>P value based Wilcoxon rank sum test or Chi-square test.</p><p>AMD-age-related macular degeneration, PCV- polypoidal choroidal vasculopathy, OCT- optical coherence tomography, CMT - central macular thickness.</p