Visual Acuity and Intraretinal Fluid as Predictive Factors for Legal Blindness and Macular Atrophy in Neovascular AMD Eyes Treated with Anti-VEGF: A Swedish Real-World Study

Isac Wickman,1 Ivana Huzevkova,1 Marion Schroeder,1 Elisabet Granstam,2 Ulrika Kjellström,1 Monica Lövestam-Adrian1 1Department of Clinical Sciences Lund, Ophthalmology, Lund University, Lund, Sweden; 2Department of Surgical Sciences, Ophthalmology, Uppsala University, Uppsala, SwedenCorrespondence: Isac Wickman, Department of Clinical Sciences Lund, Ophthalmology, Lund University, Lund, Sweden, Tel +46723871926, Fax +4646172721, Email 95isacwickman@gmail.comPurpose: Ocular coherence tomography (OCT) biomarkers have previously been able to predict low visual acuity (VA). The purpose of this study was to identify other OCT predictors for a final VA ≤ 35 and risk factors for macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD).Methods: This retrospective observational study included 107 treatment naïve nAMD eyes who initiated treatment and were followed for 3 years ± 2 months or until VA deterioration to or below 35 ETDRS letters. Eyes with final VA ≤ 35 letters (low VA group) were compared with those with a final VA > 35 letters (maintenance group). Swedish Macula Register (SMR) data and OCT images were analyzed to identify risk factors for MA development and low VA. MA was defined according to the criteria for Complete Retinal Pigment Epithelium and Outer Retinal Atrophy (cRORA), which was based on OCT parameters.Results: Twenty eyes (19%) were presented with a final VA ≤ 35 ETDRS letters. Mean time from baseline to ≤ 35 ETDRS letters was 587.7 ± 330.4 days, with a mean 9.7 ± 5.3 injections during that period. Mean baseline VA in the maintenance group vs the low VA group were 65.4 ± 10.8 and 52.0 ± 10.6, respectively; p < 0.001. Lower baseline VA was a predictor for low final VA. At baseline, 87% did not have MA on OCT. Among eyes with at least 1 OCT follow-up value in this group, 25% developed MA during the 3-year period. The presence of intraretinal fluid (IRF) at baseline was a predictor for MA development within 3 years in this subgroup.Conclusion: After 3 years, 19% had declined to VA ≤ 35 ETDRS letters. About 25% with ≥ 1 available OCT follow-ups developed MA. Lower baseline VA predicted a final VA ≤ 35 ETDRS letters in nAMD eyes. IRF at baseline predicted MA. The high prevalence of missing VA values emphasizes the importance of increasing the frequency of VA testing.Keywords: Swedish macula register, anti-VEGF, macular atrophy