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Associations of presenting visual acuity with morphological changes on OCT in neovascular age-related macular degeneration: PRECISE Study Report 2

Eye volume 38, pages 757–765 (2024)Cite this article

Subjects

Abstract

Purpose

To study associations of optical coherence tomography (OCT) features with presenting visual acuity (VA) in treatment naive neovascular age-related macular degeneration (nAMD).

Methods

Patients with nAMD initiated on aflibercept therapy were recruited from December 2019 to August 2021. Demographic and OCT (Spectralis, Heidelberg Engineering) features associated with good VA (VA ≥ 68 ETDRS letters, Snellen ≥ 6/12) and poor VA (VA < 54 letters, Snellen < 6/18) were analysed using Generalised Estimating Equations to account for inter-eye correlation.

Results

Of 2274 eyes of 2128 patients enrolled, 2039 eyes of 1901 patients with complete data were analysed. Mean age was 79.4 (SD 7.8) years, female:male 3:2 and mean VA 58.0 (SD 14.5) letters. On multivariable analysis VA < 54 letters was associated with increased central subfield thickness (CST) (OR 1.40 per 100 µm; P < 0.001), foveal intraretinal fluid (OR 2.14; P < 0.001), polypoidal vasculopathy (PCV) relative to Type 1 macular neovascularisation (MNV) (OR 1.66; P = 0.049), presence of foveal subretinal hyperreflective material (SHRM) (OR 1.73; P = 0.002), foveal fibrosis (OR 3.85; P < 0.001), foveal atrophy (OR 5.54; P < 0.001), loss of integrity of the foveal ellipsoid zone (EZ) or external limiting membrane (ELM) relative to their preservation (OR 3.83; P < 0.001) and absence of subretinal drusenoid deposits (SDD) (presence vs absence; OR 0.75; P = 0.04). These features were associated with reduced odds of VA ≥ 68 letters except MNV subtypes and SDD.

Conclusion

Presence of baseline fovea-involving atrophy, fibrosis, intraretinal fluid, SHRM, PCV EZ/ELM loss and increased CST determine poor presenting VA. This highlights the need for early detection and treatment prior to structural changes that worsen baseline VA.

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Fig. 1: Participant flow.
Fig. 2: Plot of Odds Ratio with 95% CIs showing ocular and OCT characteristics associated with VA ≥ 68 ETDRS letter score and VA < 54 ETDRS letter score—univariate and multivariable analysis using Generalised Estimating Equations (GEE).

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Data availability

The anonymised PRECISE clinical database analysed during the current study is available from author SS on approval of a data sharing agreement. Sharing of retinal images requires patient consent and sponsor approval.

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Acknowledgements

The research was funded by Boehringer Ingelheim and supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology and the NIHR Moorfields Clinical Research Facility. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Author information

Authors and Affiliations

  1. National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK

    Shruti Chandra, Bishwanath Pal, Sridevi Thottarath, Raheeba Muhamed Pakeer, Swati Chandak, Andrea Montesel & Sobha Sivaprasad

  2. Institute of Ophthalmology, University College, London, UK

    Shruti Chandra, Sarega Gurudas, Victor Chong & Sobha Sivaprasad

  3. James Paget University Hospitals NHS Foundation Trust, Norfolk, UK

    Benjamin J. L. Burton

  4. Frimley Health NHS Foundation Trust, Surrey, UK

    Geeta Menon

  5. The Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, Liverpool, UK

    Ian Pearce

  6. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Martin Mckibbin

  7. South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

    Ajay Kotagiri

  8. Newcastle Hospitals NHS Foundation Trust, Newcastle, UK

    James Talks

  9. King’s College Hospital NHS Foundation Trust, London, UK

    Anna Grabowska

  10. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK

    Faruque Ghanchi

  11. Hull York Medical School and York, University of York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK

    Richard Gale

  12. Boehringer Ingelheim, Binger Str. 173, 55216, Ingelheim am, Rhein, Germany

    Andrea Giani & Taffeta Ching Ning Yamaguchi

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Contributions

Conceptualization: ShC and SS; Data curation: ShC, ST, RMP, SC, and AM; Formal analysis: SG and SS; Funding acquisition: AGi, VC and SS; Investigation: ShC, SG and SS; Methodology: ShC, SG, and SS; Project administration: AGi. and SS; Resources: ShC, GM, BJB, IP, MM, ST, SC, RPM, AM, AK, JT, AGr, FG, RG, BP and SS; Supervision: AGi, VC and SS; Visualisation: SG and ShC; Writing – original draft: ShC, SG and SS; Writing - review & editing: AGi, VC and SS Review and approval of final manuscript: ShC, SG., AGi, VC, SS, GM, BJB, IP, MM, ST, RPM, SC, AM, AK, JT, AGr, CC, FG, RG, and BP.

Corresponding author

Correspondence to Sobha Sivaprasad.

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Competing interests

SS received consultancy fees from Bayer, Allergan, Novartis Pharma AG, Roche, Boehringer Ingelheim, Optos, Apellis, Oxurion, Oculis and Heidelberg Engineering. VC is an employee of Janssen R&D and previously of Boehringer Ingelheim. AGi is an employee of Boehringer Ingelheim. TCNY is an employee of Boehringer Ingelheim. BB is in the advisory board and received international conference attendance sponsored by Novartis and Bayer; GM has conducted consultancy-advisory boards for Novartis, Bayer and Allergan, received educational travel grants from Novartis, Bayer, Allergan; IP has received lecture fees from Allergan, Bayer, Heidelberg and Novartis, consultancy fees from Allergan, Alimera, Bayer and Novartis and travel fees from Allergan, Bayer and Novartis. FG has received honorarium for consultancy-advisory boards from Alimera, Allergan, Bayer, Novartis, Oxford BioElectronics, Roche; educational travel grants from Allergan, Bayer, Novartis. MM has received lecture and advisory board honoraria from Bayer and Novartis and an educational travel grant from Bayer. RG has conducted consultancy-advisory boards for Novartis, Bayer and Allergan, Alimera, Santen, received educational travel grants from Novartis, Bayer, Allergan, Heidelberg Engineering. JT is a consultant for Bayer and Novartis, received grant support from Bayer, Novartis and Heidelberg Engineering, and is involved in research for Allergan, Roche, Bayer, Novartis and Boehringer Ingelheim. AK received travel support from Novartis, Bayer, and Allergan, and speaker fees from Allergan and Bayer. Bishwanath Pal received travel support and received advisory boards honoraria from Novartis and Bayer. ShC, SG, ST, RMP, SC and AM have no financial disclosures. SS, FG, and ShC are members of the Eye editorial board.

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Supplementary information

41433_2023_2769_MOESM1_ESM.docx

Table S1. Ocular and OCT characteristics associated with VA>=68 ETDRS letters and VA<54 ETDRS letters – Odds Ratios (95% CI) and P-values from univariate and multivariable analysis using Generalised E

41433_2023_2769_MOESM2_ESM.docx

Table S2. Ocular and OCT characteristics associated with moderate VA comparing moderate (VA 54-67) vs good VA (VA>=68) and moderate (VA 54-67) vs poor VA (VA<54) – univariate and multivariable analysi

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Chandra, S., Gurudas, S., Burton, B.J.L. et al. Associations of presenting visual acuity with morphological changes on OCT in neovascular age-related macular degeneration: PRECISE Study Report 2. Eye 38, 757–765 (2024). https://doi.org/10.1038/s41433-023-02769-5

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