1 macular morphology and visual acuity in the comparison of age-related macular degeneration...

1

Macular Morphology and Visual Macular Morphology and Visual Acuity in the Comparison of Acuity in the Comparison of

Age-related Macular Age-related Macular Degeneration Treatments Trial Degeneration Treatments Trial

(CATT)(CATT)Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire, MG, Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire, MG,

Ying G-S, Grunwald JE, Huang J for the CATT Research Ying G-S, Grunwald JE, Huang J for the CATT Research Team Team

Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire, MG, Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire, MG, Ying G-S, Grunwald JE, Huang J for the CATT Research Ying G-S, Grunwald JE, Huang J for the CATT Research Team Team

Supported by Cooperative Agreements from the Supported by Cooperative Agreements from the National Eye Institute, National Institutes of National Eye Institute, National Institutes of

Health, DHHSHealth, DHHS

Available through Available through http://www.med.upenn.edu/cpob/publications_main.shtml

http://www.med.upenn.edu/cpob/publications_main.shtml

http://www.med.upenn.edu/cpob/publications_main.shtml

Presence and Type of Fluid on OCT Over Time

2

Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03

Impact Over Time of Drug & Dosing Impact Over Time of Drug & Dosing Regimen on OCT–Determined Thickness Regimen on OCT–Determined Thickness MeasurementsMeasurements

3


Retinal thickness category Retinal thickness category over time by treatment over time by treatment

groupgroup

4


Lesion Components Under the Foveal Center by Drug and Dosing Regimen

5Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03

WeekFoveal Intraretinal

Fluid PresentRetinal Thickness Category (µ) Ranibizumab Monthly Bevacizumab Monthly

Ranibizumab PRN

Bevacizumab PRN

0

Yes<120 3(2.0%) 3(2.1%) 7(5.3%) 5(3.4%)

120 to 212 56(38.1%) 47(33.1%) 35(26.7%) 50(33.6%)>212 88(59.9%) 92(64.8%) 89(67.9%) 94(63.1%)

No<120 28(19.2%) 22(16.4%) 24(15.3%) 25(17.5%)

120 to 212 105(71.9%) 95(70.9%) 110(70.1%) 100(69.9%)>212 13(8.9%) 17(12.7%) 23(14.6%) 18(12.6%)

4

Yes<120 5(7.4%) 3(4.1%) 4(6.1%) 5(6.6%)

120 to 212 47(69.1%) 43(58.9%) 48(72.7%) 48(63.2%)>212 16(23.5%) 27(37.0%) 14(21.2%) 23(30.3%)

No<120 55(25.7%) 45(22.6%) 51(23.4%) 41(20.4%)

120 to 212 148(69.2%) 139(69.8%) 153(70.2%) 139(69.2%)>212 11(5.1%) 15(7.5%) 14(6.4%) 21(10.4%)

12

Yes<120 6(10.2%) 6(10.0%) 5(7.7%) 8(8.2%)

120 to 212 41(69.5%) 35(58.3%) 33(50.8%) 57(58.2%)>212 12(20.3%) 19(31.7%) 27(41.5%) 33(33.7%)

No<120 50(24.4%) 34(17.8%) 44(21.5%) 32(18.7%)

120 to 212 148(72.2%) 148(77.5%) 154(75.1%) 127(74.3%)>212 7(3.4%) 9(4.7%) 7(3.4%) 12(7.0%)

24

Yes<120 3(6.5%) 6(9.5%) 3(5.3%) 8(10.1%)

120 to 212 30(65.2%) 34(54.0%) 34(59.6%) 43(54.4%)>212 13(28.3%) 23(36.5%) 20(35.1%) 28(35.4%)

No<120 46(21.7%) 36(20.0%) 53(25.6%) 36(20.8%)

120 to 212 159(75.0%) 134(74.4%) 142(68.6%) 128(74.0%)>212 7(3.3%) 10(5.6%) 12(5.8%) 9(5.2%)

52

Yes<120 2(7.7%) 6(11.8%) 4(8.7%) 4(7.0%)

120 to 212 17(65.4%) 23(45.1%) 27(58.7%) 33(57.9%)>212 7(26.9%) 22(43.1%) 15(32.6%) 20(35.1%)

No<120 69(28.4%) 42(20.8%) 49(22.0%) 49(24.0%)

120 to 212 163(67.1%) 146(72.3%) 161(72.2%) 139(68.1%)>212 11(4.5%) 14(6.9%) 13(5.8%) 16(7.8%)

Foveal Lesion CompositionFoveal Lesion Composition

6


Baseline

Week 52

Involvement of the foveal center by Involvement of the foveal center by CNV or sequelae of CNV at week 52 CNV or sequelae of CNV at week 52

7

(A) Ranibizumab Monthly

(B) Bevacizumab Monthly

(C) Ranibizumab PRN

(D) Bevacizumab PRN

Fluid Only10.9%

CNV21.5%

SPED0.4%

Scar16.2%RPE Tears

1.5%Other2.3%

No Pathology17.7%

Can't Grade3.0%

Blocked Fluorescence

5.3%

Non-geographic Atrophy

18.5%

Geographic Atrophy

2.6%Fluid Only 8.2%

CNV 21.2%

SPED 0.4%

Scar 20.4%RPE Tears 0.8%

Other 4.9%

No Pathology 24.9%

Can't Grade 1.6%


4.9%

Non-geographic Atrophy 11.8%

Geographic Atrophy 0.8%

Fluid Only 4.5%

CNV 26.5%

SPED 1.1%

Scar 19.0%Hemorrhage

0.7%RPE Tear 0.7%

Other 4.8%

No Pathology 20.1%

Can't Grade 3.4%


3.4%


Geographic Atrophy 1.1% Fluid Only 9.4%

CNV 29.8%

SPED 0.4%

Scar 18.8%

Hemorrhage 0.4%

RPE Tears 0.8%

Other 3.9%

No Pathology 16.1%

Can't Grade 2.4%


1.6%


Geographic Atrophy 3.1%

Mean visual acuity by status of fluid

8


Retinal thickness and Visual Acuity Retinal thickness and Visual Acuity at Baseline and Follow-upat Baseline and Follow-up


Nonlinear relationship of visual Nonlinear relationship of visual acuity with foveal total thickness acuity with foveal total thickness

during follow-up during follow-up


Mean VA by Neovascular Lesion Area and Pathology in Foveal Center at Week 52

(N=1053)


Fundus Feature at Week 52 N

Unadjusted Mean Visual Acuity

Score (Standard Error)

P values*

Neovascular lesion area (mm2) <0.0001

≥0 to ≤1.92 244 74.3 (1.11) >1.92 to ≤4.96 246 70.4 (1.10) >4.96 to ≤9.62 245 67.1 (1.10) >9.62 242 61.9 (1.11)

Missing 76 63.1 (1.98) Pathology in foveal center <0.0001

None 202 73.9 (1.20) Fluid only 85 75.3 (1.85) Choroidal

neovascularization or serous pigment epithelium detachment

259

69.7 (1.06)

Non-geographic atrophy 151 66.5 (1.39) Geographic atrophy,

hemorrhage, RPE§ tear, blocked fluorescence

7264.8 (2.01)

Scar 188 59.5 (1.25) Other§ or missing 96 66.8 (1.75) *1-way analysis of variance

RPE = retinal pigment epithelium§Other includes pigment, drusenoid pigment epithelial detachment and non-leaking choroidal neovascularization

Adjusted Mean Visual Acuity for OCT and Fundus Features at Week 52 (n=1004)∗


*Subjects (n=49) with missing data for fluid or retinal thickness were excluded.CNV= choroidal neovascularizationRPE = retinal pigment epithelium

ConclusionsConclusions

Anti–vascular endothelial growth factor (VEGF) therapy Anti–vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment reduced lesion activity and improved VA in all treatment groups. groups.

At all time points, eyes with residual IRF had worse VA than At all time points, eyes with residual IRF had worse VA than those without.those without.

Eyes with abnormally thin or thick retinas, residual large Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA.lesions, and scar also had worse VA.

Monthly ranibizumab dosing yielded more eyes with no fluid Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term and an abnormally thin retina, although the long-term significance is unknown.significance is unknown.

These results have important treatment implications in eyes These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular undergoing anti-VEGF therapy for neovascular


1 macular morphology and visual acuity in the comparison of age-related macular degeneration...

Documents

macular morphology

comparison of

foveal center

foveal total thickness

foveal lesion composition

lesion components

time of drug dosing

neovascular lesion area