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
. 2025 Sep 25;15(1):32881.
doi: 10.1038/s41598-025-17417-z.

Impact of AI-quantified fluid dynamics on visual outcomes over 5 years in patients with treatment-naïve nAMD from the FRB! registry

Philipp Fuchs  1 , Ursula Schmidt-Erfurth  2   3 , Leonard M Coulibaly  1 , Hrvoje Bogunovic  1 , Oliver Leingang  1 , Anastasiia Gruber  1   4 , Florian Frommlet  4 , Virginia Mares  1   5 , Daniel Barthelmes  6 , Gregor S Reiter  1
Affiliations

Impact of AI-quantified fluid dynamics on visual outcomes over 5 years in patients with treatment-naïve nAMD from the FRB! registry

Philipp Fuchs et al. Sci Rep. .

Abstract

To investigate the impact of retinal fluid dynamics on visual outcomes in patients with treatment-naïve neovascular age-related macular degeneration (nAMD) treated in the real world over 5 years using approved AI-based fluid monitoring. Real-world data comprising OCT scans and electronic medical records from 148 patients (187 eyes) were extracted from the Fight Retinal Blindness! (FRB! ) Zürich database. OCT scans were analysed using an approved AI algorithm (RetInSight, Vienna, Austria) to quantify fluid volumes by compartements. The impact of fluid persistence and fluctuations on BCVA change was assessed using forward stepwise regression and mixed models. Fluid compartments were further categorized into quartiles (SD-Qs), and the effect of fluid fluctuations on BCVA analysed (SD-Q1 least and SD-Q4 greatest variability of fluctuations). The greatest PED fluctuations in the central 1-mm showed an accentuated BCVA decrease after 2 and 4 years (estimate: -0.07, P = 0.019; estimate: -0.15, P < 0.01). After 4 years, eyes in SD-Q4 compared with SD-Q1 with greater PED fluctuations in the central 1-mm and 6-mm area were affected by a significant mean reduction in BCVA (-5.7 letters (P = 0.013); -6.1 letters (P = 0.015)). Greater intraretinal fluid (IRF) fluctuations (central 1-mm) (SD-Q4 compared with SD-Q1) were associated with a significantly worse mean BCVA by -6.8 letters (P = 0.018) after 5 years. Fluid persistence was not associated with statistically significant BCVA changes. In routine clinical management of nAMD, greater fluctuations of PED and IRF correlate with worse BCVA outcomes over long-term follow-up. A well-suited treatment regimen is required in the real world which can be utilized with AI-based fluid monitoring.

Keywords: Anti-VEGF; Artificial intelligence; Fluid dynamics; Fluid fluctuations; Fluid persistence; Neovascular AMD; OCT.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: GSR: Grant from RetInSight. US-E: Scientific consultancy for Apellis, Novartis, Roche, Heidelberg Engineering, Kodiak, RetInSight, Topcon. DB: Scientific consultancy, grants and speaker fees for Bayer and Novartis. HB: Grants from Heidelberg Engineering and Apellis. Speaker fees from Bayer, Roche, and Apellis. VM, OL, PF, LC, FF, AG: No financial support or conflicts of interest. The other authors declare no competing interests. Ethical approval: The study was conducted in adherence with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board (Cantonal Ethics Committee Zurich, Switzerland) for data use and by the Medical University of Vienna (Vienna, Austria) Ethics Committee for the post hoc analysis. Due to the retrospective nature of the study, the need to obtain informed consent was waived by the Cantonal Ethics Committee Zurich, Switzerland, for data use, and by the Ethics Committee of the Medical University of Vienna, Austria, for the post hoc analysis.

Figures

Fig. 1
Fig. 1
Automatically and manually patient’s exclusion criteria. Patients/eyes that were excluded from the study for two different reasons could be in both of the respective exclusion groups.
Fig. 2
Fig. 2
B-scan segmentation with the Vienna Fluid Monitor. (a) Representative B-scan on SD-OCT (left), B-scan segmented using the Fluid Monitor algorithm: automated segmentation of intraretinal fluid (yellow) and subretinal fluid (blue) (right). (b) Representative B-scan on SD-OCT (left): automated segmentation of subretinal fluid (blue) and pigment epithelial detachment (orange) (right).
Fig. 3
Fig. 3
Distribution of patients and eyes per OCT-BCVA matching window.
Fig. 4
Fig. 4
Mean and 95% confidence intervals of BCVA change from Month 3 to Month 15, 27, 39, 51 and 63 by IRF, SRF and PED fluctuations (Standard Deviation) in Quartiles 1 to 4 in the central 1-mm area. Mean BCVA changes for the Quartiles 1 to 4 for the OCT Biomarker of IRF fluctuation from Month 3 to Month 15 (a), Month 27 (b), Month 39 (c), Month 51 (d), Month 63 (e), BCVA changes for the Quartiles 1 to 4 for the OCT Biomarker of SRF fluctuation from Month 3 to Month 15 (f), Month 27 (g), Month 39 (h), Month 51 (i), Month 63 (j), BCVA changes for the Quartiles 1 to 4 for the OCT Biomarker of PED fluctuation from Month 3 to Month 15 (k), Month 27 (l), Month 39 (m), Month 51 (n), Month 63 (o).
See this image and copyright information in PMC

References

    1. Abràmoff, M. D. et al. Automated analysis of retinal images for detection of referable diabetic retinopathy. JAMA Ophthalmol.131, 351–357. 10.1001/jamaophthalmol.2013.1743 (2013). - PubMed
    1. Spaide, R. F. et al. Consensus nomenclature for reporting neovascular age-related macular degeneration data: consensus on neovascular Age-Related macular degeneration nomenclature study group. Ophthalmology127, 616–636. 10.1016/j.ophtha.2019.11.004 (2020). - PMC - PubMed
    1. Sarraf, D. et al. Pigment epithelial detachment thickness and variability affects visual outcomes in patients with neovascular age-related macular degeneration. Retina44, 10–19. 10.1097/IAE.0000000000003935 (2024). - PubMed
    1. Wong, T. et al. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology11510.1016/J.OPHTHA.2007.03.008 (2008). - PubMed
    1. Jaffe, G. J. et al. Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials. Ophthalmology 1860–1870 (2013). - PMC - PubMed

LinkOut - more resources