title: Foveal morphology affects self-perceived visual function and treatment response in neovascular age-related macular degeneration: a cohort study.
abstract: OBJECTIVE
  To investigate the relationship between foveal morphology and self-perceived visual function in patients with neovascular age-related macular degeneration (AMD) and whether foveal characteristics are associated with Ranibizumab treatment response on the self-perceived visual function.
  
  
  METHODS
  This prospective cohort study included patients with newly diagnosed neovascular AMD found eligible for treatment with Ranibizumab. Foveal morphology of both eyes was assessed using spectral-domain optical coherence tomography and all patients were interviewed using the 39-item National Eye Institute Visual Function Questionnaire (VFQ). Patients were re-interviewed 3 and 12 months after initiation of treatment with Ranibizumab. We evaluated foveal morphology at baseline in relation to VFQ scores at baseline and clinically meaningful changes in VFQ after 3 and 12 months.
  
  
  RESULTS
  VFQ scores correlated with central foveal thickness, central foveal thickness of neuroretina (CFN), foveal RPE elevation, foveal integrity of the photoreceptor inner segment/outer segment junction (IS/OS), and external limiting membrane. In a multiple linear regression model, only best-corrected visual acuity of the better eye (p<0.001) and the IS/OS status in the better eye (p = 0.012) remained significant (Adjusted R(2) = 0.418). Lower baseline VFQ and a baseline CFN within 170-270 µm in the better eye were both associated with a clinically meaningful increase in the VFQ scores after 3 and 12 months. An absent foveal IS/OS band in the better eye was associated with a clinically meaningful decrease in the VFQ scores at 12 months.
  
  
  CONCLUSIONS
  Foveal morphology in the better eye influences the self-perceived visual function in patients with neovascular AMD and possesses a predictive value for change in the self-perceived visual function at 3 and 12 months after initiation of treatment. These findings may help clinicians provide patients more individualized information of their disease and treatment prognosis from a patient-perceived point-of-view.
authors.affiliation: Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark; University of Copenhagen, Copenhagen, Denmark.
authors.forename: Yousif
authors.initials: Y
authors.lastname: Subhi
authors.affiliation: Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark.
authors.forename: Gitte Ø
authors.initials: GØ
authors.lastname: Henningsen
authors.affiliation: Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark.
authors.forename: Charlotte T
authors.initials: CT
authors.lastname: Larsen
authors.affiliation: Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark.
authors.forename: Mette S
authors.initials: MS
authors.lastname: Sørensen
authors.affiliation: Clinical Eye Research Unit, Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark; University of Copenhagen, Copenhagen, Denmark.
authors.forename: Torben L
authors.initials: TL
authors.lastname: Sørensen
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015331:Cohort Studies; D005584:Fovea Centralis / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D000069579:Ranibizumab; D055213:Retinal Pigment Epithelium; D011795:Surveys and Questionnaires; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab