title: Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials.
abstract: OBJECTIVE
  To describe the effects of treatment for 1 year with ranibizumab or bevacizumab on macular morphology and the association of macular morphology with visual acuity (VA) in eyes with neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Prospective cohort study within a randomized clinical trial.
  
  
  METHODS
  Participants in the Comparison of Age-related Macular Degeneration Treatments Trials.
  
  
  METHODS
  Participants were assigned randomly to treatment with ranibizumab or bevacizumab on a monthly or as-needed schedule. Optical coherence tomography (OCT), fluorescein angiography (FA), color fundus photography (FP), and VA testing were performed periodically throughout 52 weeks. Masked readers graded images. General linear models were applied to evaluate effects of time and treatment on outcomes.
  
  
  METHODS
  Fluid type and location and thickness by OCT, size, and lesion composition on FP, FA, and VA.
  
  
  RESULTS
  Intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid, and retinal, subretinal, and subretinal tissue complex thickness decreased in all treatment groups. A higher proportion of eyes treated monthly with ranibizumab had fluid resolution at 4 weeks, and the difference persisted through 52 weeks. At 52 weeks, there was little association between the presence of fluid of any type (without regard to fluid location) and the mean VA. However, at all time points, eyes with residual IRF, especially foveal IRF, had worse mean VA (9 letters) than those without IRF. Eyes with abnormally thin (<120 μm) or thick (>212 μm) retinas had worse VA than those with normal thickness (120-212 μm). At week 52, eyes with larger neovascular lesions or with foveal scar had worse VA than eyes without these features.
  
  
  CONCLUSIONS
  Anti-vascular endothelial growth factor (VEGF) therapy reduced lesion activity and improved VA in all treatment groups. At all time points, eyes with residual IRF had worse VA than those without. Eyes with abnormally thin or thick retinas, residual large lesions, and scar also had worse VA. Monthly ranibizumab dosing yielded more eyes with no fluid and an abnormally thin retina, although the long-term significance is unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for neovascular AMD.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors: Department of Ophthalmology, Duke University, Durham, North Carolina 27710, USA. jaffe001@mc.duke.edu
authors: Glenn J
authors: GJ
authors: Jaffe
authors: Daniel F
authors: DF
authors: Martin
authors: Cynthia A
authors: CA
authors: Toth
authors: Ebenezer
authors: E
authors: Daniel
authors: Maureen G
authors: MG
authors: Maguire
authors: Gui-Shuang
authors: GS
authors: Ying
authors: Juan E
authors: JE
authors: Grunwald
authors: Jiayan
authors: J
authors: Huang
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D011446:Prospective Studies; D000069579:Ranibizumab; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab
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