title: Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials.
abstract: OBJECTIVE
  To evaluate the association of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA), and scar in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
  
  
  METHODS
  Prospective cohort study within a randomized clinical trial.
  
  
  METHODS
  The 1185 CATT participants.
  
  
  METHODS
  Masked readers graded scar and GA on fundus photography and fluorescein angiography and graded SHRM on time-domain and spectral-domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1 mm(2), or outside the center 1mm(2) were obtained on SD OCT images at 56 (n = 76) and 104 (n = 66) weeks.
  
  
  METHODS
  Presence of SHRM, as well as location and size, and associations with VA, scar, and GA.
  
  
  RESULTS
  Among CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and to 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved (64% vs. 31%; P < 0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n = 76) and 104 (n = 66), mean VA letter score was 73.5 (standard error [SE], 2.8), 73.1 (SE, 3.4), 65.3 (SE, 3.5), and 63.9 (SE, 3.7) when SHRM was absent, present outside the central 1 mm(2), present within the central 1 mm(2) but not the foveal center, or present at the foveal center (P = 0.02), respectively. When SHRM was present, the median maximum height under the fovea, within the central 1 mm(2) including the fovea and anywhere within the scan, was 86 μm, 120 μm, and 122 μm, respectively. Visual acuity was decreased with greater SHRM height and width (P < 0.05).
  
  
  CONCLUSIONS
  In eyes with neovascular age-related macular degeneration (AMD), SHRM is common and often persists after anti-vascular endothelial growth factor treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM dimensions were associated with worse VA. In eyes with neovascular AMD, SHRM is an important morphologic biomarker.
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Alex S
authors.initials: AS
authors.lastname: Willoughby
authors.affiliation: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Toth
authors.affiliation: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Maguire
authors.affiliation: Duke Reading Center, Durham, North Carolina.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Burns
authors.affiliation: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Grunwald
authors.affiliation: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina. Electronic address: glenn.jaffe@dm.duke.edu.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Jaffe
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D002921:Cicatrix / Q000175:diagnosis*; D005451:Fluorescein Angiography; D057092:Geographic Atrophy / Q000503:physiopathology; D006801:Humans; D058449:Intravitreal Injections; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab; D012160:Retina / Q000473:pathology*; D055213:Retinal Pigment Epithelium; 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*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab