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. 2024 Jan 1;44(1):10-19.
doi: 10.1097/IAE.0000000000003935.

PIGMENT EPITHELIAL DETACHMENT THICKNESS AND VARIABILITY AFFECTS VISUAL OUTCOMES IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

David Sarraf  1 , Arshad M Khanani  2   3 , SriniVas R Sadda  4 , Andrew Chang  5 , David T Wong  6 , Anne-Sophie Kempf  7 , Insaf Saffar  7 , Shuhan Tang  7 , Ramin Tadayoni  8   9
Affiliations

PIGMENT EPITHELIAL DETACHMENT THICKNESS AND VARIABILITY AFFECTS VISUAL OUTCOMES IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

David Sarraf et al. Retina. .

Abstract

Purpose: To evaluate the impact of pigment epithelial detachment (PED) thickness (i.e., height) and thickness variability on best-corrected visual acuity outcomes in patients with neovascular age-related macular degeneration in the Phase 3 HAWK and HARRIER trials.

Methods: Optical coherence tomography images from the pooled brolucizumab 6 mg and aflibercept 2 mg arms were analyzed for the maximum PED thickness across the macula at baseline through to week 96. Best-corrected visual acuity outcomes were compared in patients with different PED thickness and variability cut-off thresholds.

Results: Greater PED thickness at baseline or at week 12 was associated with lower mean best-corrected visual acuity gain from baseline to week 96 (baseline PED ≥200 µ m: +4.6 letters; <200 µ m: +7.0 letters; week 12 PED ≥100 µ m: +5.6 letters; <100 µ m: +6.6 letters). Eyes with the largest PED thickness variability from week 12 through week 96 gained fewer letters from baseline at week 96 (≥33 µ m: +3.3 letters; <9 µ m: +6.2 letters). Furthermore, increased PED thickness at week 48 was associated with higher prevalence of intraretinal and subretinal fluid.

Conclusion: In this treatment-agnostic analysis, greater PED thickness and PED thickness variability were associated with poorer visual outcomes in patients with neovascular age-related macular degeneration and greater neovascular activity.

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Comment in

  • Reply.
    Faghihi S, Omidtabrizi A, Feo A, Sarraf D. Faghihi S, et al. Retina. 2025 Feb 1;45(2):e12-e14. doi: 10.1097/IAE.0000000000004316. Retina. 2025. PMID: 39485995 No abstract available.
  • Correspondence.
    Clemens CR, Eter N, Alten F. Clemens CR, et al. Retina. 2025 Feb 1;45(2):e12. doi: 10.1097/IAE.0000000000004315. Retina. 2025. PMID: 39486000 No abstract available.

References

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    1. Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012;119:2537–2548.
    1. Dugel PU, Koh A, Ogura Y, et al. HAWK and HARRIER: phase 3, multicenter, randomized, double-masked trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology 2020;127:72–84.
    1. Dugel PU, Singh RP, Koh A, et al. HAWK and HARRIER: ninety-six-week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology 2021;128:89–99.
    1. Nagiel A, Sarraf D, Sadda SR, et al. Type 3 neovascularization: evolution, association with pigment epithelial detachment, and treatment response as revealed by spectral domain optical coherence tomography. Retina 2015;35:638–647.

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