Foveal threshold and photoreceptor integrity for prediction of visual acuity after intravitreal aflibercept on age-related macular degeneration

Abstract

Purpose: To determine whether baseline foveal threshold and photoreceptor integrity can predict best-corrected visual acuity (BCVA) at 12 months after intravitreal aflibercept (IVA) therapy in eyes with neovascular age-related macular degeneration (AMD).

Patients and methods: We evaluated 25 eyes of 25 patients with treatment-naïve neovascular AMD who received IVA once a month for 3 months, followed by once every 2 months for 8 months. BCVA, integrity of the external limiting membrane (ELM) or the ellipsoid zone (EZ) of the photoreceptors, and retinal sensitivity were determined before (baseline) and at 6 and 12 months after initial IVA. The average threshold foveal sensitivity and mean deviation within the central 10° were determined by Humphrey central 10-2 perimetry. Correlations between BCVA at 12 months and integrity of the ELM or EZ, foveal threshold, and mean deviation at each visit were determined.

Results: At 12 months, BCVA improved significantly from 0.20±0.23 to 0.10±0.22 logMAR (logarithm of the minimum angle of resolution) units, and foveal threshold and mean deviation improved significantly from 29.0±5.1 and -3.38±3.10 dB to 32.6±3.2 and -1.64±2.10 dB, respectively (P=0.0009 and P=0.0021). At baseline, both foveal threshold and integrity of the ELM were significantly correlated with BCVA at 12 months (P=0.0428 and P=0.0275).

Conclusion: These results indicate that both integrity of the ELM and foveal threshold at baseline can predict BCVA after treatment for neovascular AMD. There is a possibility that these parameters can predict the efficacy of IVA in each case.

Keywords: aflibercept; age-related macular degeneration; foveal photoreceptor integrity; foveal threshold.

Figure 1

Assessment of optical coherence tomography images of patients with age-related macular degeneration treated with intravitreal aflibercept. Note: We evaluated the presence of ELM and EZ at fovea. Abbreviations: ELM, external limiting membrane; EZ, ellipsoid zone.

Figure 2

Results of assessments of functional and morphologic parameters of eyes with neovascular age-related macular degeneration treated with IVA injections over a 12-month period. Notes: Assessments were made before the IVA and 3, 6, 9, and 12 months after the IVA. (A) Best-corrected visual acuity (logMAR units). (B) Lesion size. (C) Central retinal thickness. (D) MD. (E) Foveal sensitivity. Abbreviations: BCVA, best-corrected visual acuity; IVA, intravitreal aflibercept; logMAR, logarithm of minimal angle of resolution; MD, mean deviation.

Figure 3

Scatterplots showing the relationship between change in lesion size over 12 months and change in MD for each treated eye. Abbreviation: MD, mean deviation.

Figure 4

Grade of ELM and EZ of eyes with neovascular age-related macular degeneration treated with IVA injections over a 12-month period. Note: Assessments were made before the IVA and 6 and 12 months after the IVA. Abbreviations: ELM, external limiting membrane; EZ, ellipsoid zone; IVA, intravitreal aflibercept.

Figure 5

(A) Scatterplots showing the relationship between final best-corrected visual acuity (logMAR units) and baseline foveal threshold (dB) for each treated eye. (B) Scatterplots showing the relationship between final best-corrected visual acuity (logMAR units) and baseline integrity of the ELM for each treated eye. Abbreviations: BCVA, best-corrected visual acuity; ELM, external limiting membrane; logMAR, logarithm of minimal angle of resolution.