Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Feb 20:12:369-375.
doi: 10.2147/OPTH.S151999. eCollection 2018.

Visual acuity loss associated with excessive "dry macula" in exudative age-related macular degeneration

Hidenori Takahashi  1   2   3 , Yuji Inoue  1   2 , Xue Tan  2   3 , Satoru Inoda  1 , Shinichi Sakamoto  1 , Yusuke Arai  1 , Yasuo Yanagi  4   5   6 , Yujiro Fujino  2   3 , Hidetoshi Kawashima  1
Affiliations

Visual acuity loss associated with excessive "dry macula" in exudative age-related macular degeneration

Hidenori Takahashi et al. Clin Ophthalmol. .

Abstract

Purpose: To investigate the correlation between visual acuity and central macular thickness (CMT) and choroidal thickness (CCT) in patients with wet age-related macular degeneration (AMD).

Methods: In this retrospective analysis, 14 eyes that received >10 ranibizumab injections (based on pro re nata [PRN] regimen) and maintained initial visual acuity gain were analyzed. The following 5 parameters were measured at the foveal center: CMT (distance from the inner limiting membrane [ILM] to Bruch's membrane); central retinal thickness (CRT; distance from the ILM to the inner limit of the retinal pigment epithelium or subretinal fluid [SRF]); SRF thickness (SRFT); pigment epithelium detachment thickness (PEDT); and CCT. The correlation between the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and the 5 parameters was examined with generalized estimating equations.

Results: CMT, CRT, and CCT were negatively correlated with logMAR BCVA (P=0.031, 0.023, and 0.036, respectively) when only CMT values less than the thickness that maximized visual acuity for each eye were used for the analysis. Each 100-μm reduction in CMT, CRT, or CCT improved logMAR BCVA by -0.1, -0.08, or -0.07, respectively. SRFT and PEDT were not correlated with BCVA. The median CMT that maximized the visual acuity was 230 μm.

Conclusion: Dry macula with CMT <230 μm was associated with temporary decrease in visual acuity in AMD patients whose visual acuity was maintained with PRN regimen.

Keywords: age-related macular degeneration; dry macula; intravitreal injections; ranibizumab; visual acuity.

PubMed Disclaimer

Conflict of interest statement

Disclosure HT reports grants and personal fees from Novartis Pharmaceuticals, personal fees from Bayer Yakuhin, personal fees from Santen Pharmaceutical, personal fees from Kowa Pharmaceutical, and personal fees from Tochigi Prefectural Ophthalmologists Association, outside the submitted work. YI reports personal fees from Novartis Pharmaceuticals, Mitsubishi-Tanabe Pharmaceutical, and Tochigi Prefectural Ophthalmologists Association, outside the submitted work. YY reports personal fees from Novartis Pharmaceuticals, Bayer Healthcare, and Santen Pharmaceutical, outside the submitted work. HK reports personal fees from Santen Pharmaceutical, Mitsubishi-Tanabe Pharmaceutical, and Senju Pharmaceutical, outside the submitted work. XT, SI, SS, YA, and YF report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Regression quadratic functions of the relationship between CMT and visual acuity in representative cases. Notes: (A) A 71-year-old woman with PCV was examined 26 times and received 15 ranibizumab injections over a period of 29 months from initial examination. With a linear coefficient of 0, quadratic approximation gave the following BCVA: BCVA =−0.0446+3.29e−6*(CMT −312)^2. The best BCVA in this patient was logMAR −0.0792, and the best CMT (mean CMT from 12 examinations with this visual acuity) was 284 μm. (B) A 71-year-old man with type 1 CNV. (C) A 72-year-old man with PCV. (D) A 76-year-old man with type 1 CNV. (E) An 80-year-old woman with PCV. (F) An 81-year-old man with PCV. (G) An 84-year-old man with PCV. (H) A 92-year-old woman with PCV. (I) An 84-year-old woman with PCV. (J) A 72-year-old woman with type 1 CNV. (K) A 67-year-old man with type 2 CNV. (L) A 78-year-old man with type 1 CNV. (M) A 79-year-old man with PCV. (N) A 72-year-old man with PCV. Abbreviations: CMT, central macular thickness; PCV, polypoidal choroidal vasculopathy; BCVA, best-corrected visual acuity; CNV, choroidal neovascularization; logMAR, logarithm of the minimum angle of resolution.
Figure 2
Figure 2
Optical coherence tomography of the 71-year-old woman with polypoidal choroidal vasculopathy. Notes: (A) Seven months after initial intravitreal injections of ranibizumab, logMAR BCVA was 0 and CMT was 251 μm. (B) Ten months after initial intravitreal injections of ranibizumab, logMAR BCVA was −0.079 and CMT was 291 μm. (C) Fourteen months after initial intravitreal injections of ranibizumab, logMAR BCVA was logMAR −0.041 and CMT was 381 μm. Abbreviations: logMAR, logarithm of the minimum angle of resolution; BCVA, best-corrected visual acuity; CMT, central macular thickness.
Figure 3
Figure 3
Long-term visual acuity prognosis of all 14 patients. Notes: Prognosis was (A) longer in half of the patients and (B) shorter in half of the patients. Visual acuity prognosis was stable in most of the patients. Abbreviation: logMAR, logarithm of the minimum angle of resolution.
See this image and copyright information in PMC

References

    1. Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(2):e106–e116. - PubMed
    1. Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. Martin DF, Maguire MG, Fine SL, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology. 2012;119(7):1388–1398. - PMC - PubMed
    1. Rosenfeld PJ, Brown DM, Heier JS, et al. MARINA Study Group Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419–1431. - PubMed
    1. Brown DM, Kaiser PK, Michels M, et al. ANCHOR Study Group Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1432–1444. - PubMed
    1. Chakravarthy U, Harding SP, Rogers CA, et al. IVAN study investigators Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet. 2013;382(9900):1258–1267. - PubMed