title: Macular Morphology and Visual Acuity in the Second Year of the Comparison of Age-Related Macular Degeneration Treatments Trials.
abstract: OBJECTIVE
  To describe the association between morphologic features on fundus photography (FP), fluorescein angiography (FA), and optical coherence tomography (OCT) and visual acuity (VA) in the second year of the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).
  
  
  METHODS
  Prospective cohort study within a randomized clinical trial.
  
  
  METHODS
  Participants in the CATT.
  
  
  METHODS
  Study eye eligibility required angiographic and OCT evidence of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and VA between 20/25 and 20/320. Treatment was assigned randomly to ranibizumab or bevacizumab with 3 different dosing regimens over a 2-year period.
  
  
  METHODS
  Fluid type, location, and thickness; retina and subretinal tissue complex thickness on OCT; size and lesion composition on FP and FA; and VA.
  
  
  RESULTS
  Among 1185 CATT participants, 993 (84%) had fluid on OCT at baseline and completed 2 years of follow-up. At 2 years, intraretinal fluid (IRF), subretinal fluid (SRF), sub-retinal pigment epithelium (RPE) fluid, and subretinal tissue complex thickness decreased in all treatment groups. Ranibizumab monthly was best able to resolve each type of fluid. Eyes with SRF in the foveal center on OCT had better mean VA than eyes with no SRF (72.8 vs. 66.6 letters; P = 0.006). Eyes with IRF in the foveal center had worse mean VA than eyes without IRF (59.9 vs. 70.9 letters; P < 0.0001). Eyes with retinal thickness <120 μm had worse VA compared with eyes with retinal thickness 120 to 212 and >212 μm (59.4 vs. 71.3 vs. 70.3 letters; P < 0.0001). At 2 years, the mean VA (letters) of eyes varied substantially by the type of subfoveal pathology on FP and FA: 70.6 for no pathology; 74.1 for fluid only; 73.3 for CNV or pigment epithelial (RPE) detachment; 68.4 for nongeographic atrophy; and 62.9 for geographic atrophy, hemorrhage, RPE tear, or scar (P < 0.0001).
  
  
  CONCLUSIONS
  The associations between VA and morphologic features identified through year 1 were maintained or strengthened during year 2. Eyes with foveal IRF, abnormally thin retina, greater thickness of the subretinal tissue complex on OCT, and subfoveal geographic atrophy or scar on FP/FA had the worst VA. Subretinal fluid was associated with better VA.
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Sumit
authors.initials: S
authors.lastname: Sharma
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, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Grunwald
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Maguire
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jiayan
authors.initials: J
authors.lastname: Huang
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Martin
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina. Electronic address: jaffe001@mc.duke.edu.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Jaffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005451:Fluorescein Angiography; D057092:Geographic Atrophy / Q000175:diagnosis; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D010781:Photography; D011446:Prospective Studies; D000069579:Ranibizumab / Q000627:therapeutic use*; D055213:Retinal Pigment Epithelium / Q000473:pathology; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab