title: Blood flow velocity measured using the Retinal Function Imager predicts successful ranibizumab treatment in neovascular age-related macular degeneration: early prospective cohort study.
abstract: OBJECTIVE
  Anti-VEGF treatment has a potent vasoconstrictive effect. Early changes of retinal blood flow velocity (RBFV) measured using the Retinal Function Imager (RFI) combined with indicators of vascular status may help in predicting the visual outcome 1 month post injection in patients with neovascular age-related macular degeneration (nvAMD) under ranibizumab treatment. To develop a simple prediction model based on the change in RBFV 3 days post injection and indicators of a patient's vascular status to assess the probability of a successful visual outcome 1 month post injection.
  
  
  METHODS
  RBFV measured using RFI were prospectively collected pre-injection and 3 days post injection in 18 eyes of 15 patients. Indicators of vascular status (history of hypertension, diabetes mellitus without retinal affection, and smoking) were assessed by medical history. By univariate analyses, parameters associated with visual outcome were weighted (-1 to 6 points). A multivariate logistic regression model with the categorized visual outcome parameter (≥0 letters gained after 1 month) as the dependent variate and the sum score as the independent variate (continuous scale) was used to estimate the score value-specific probabilities of letters gained ≥0 1 month post injection.
  
  
  RESULTS
  The indicators of vascular status negatively influenced the likelihood of a letter gain ≥0 whereas an increase in the arterial RBFV strongly increased it. The area under the receiver operating characteristics curve for these parameters investigated was 0.71 (95% CI: 0.43-1.00).
  
  
  CONCLUSIONS
  Changes in the arterial RBFV following 3 days after ranibizumab injection combined with three indicators of the vascular status identified nvAMD patients with favorable visual outcome accurately.
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: S C
authors.initials: SC
authors.lastname: Böhni
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: J P
authors.initials: JP
authors.lastname: Howell
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Bittner
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Faes
authors.affiliation: Medignition Inc. Research Consultants, Zurich, Switzerland.
authors.forename: L M
authors.initials: LM
authors.lastname: Bachmann
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: M A
authors.initials: MA
authors.lastname: Thiel
authors.affiliation: Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: M K
authors.initials: MK
authors.lastname: Schmid
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D001783:Blood Flow Velocity / Q000502:physiology; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D015233:Models, Statistical; D011446:Prospective Studies; D000069579:Ranibizumab / Q000627:therapeutic use*; D012039:Regional Blood Flow / Q000502:physiology; D012161:Retinal Artery / Q000502:physiology*; D049489:Stroboscopy / Q000295:instrumentation* / Q000379:methods; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab