Predictive Value of Spectral-Domain Optical Coherence Tomography Features in Assessment of Visual Prognosis in Eyes With Neovascular Age-Related Macular Degeneration Treated With Ranibizumab

PURPOSE: To determine whether pretreatment (baseline) optical coherence tomography (OCT) features can be used as predictors of visual acuity outcome at 12 months in eyes with neovascular age-related macular degeneration treated with intravitreal ranibizumab and to assess whether baseline OCT features can predict a change in visual acuity from baseline to 12 months. DESIGN: Retrospective, observational study. METHODS: We retrospectively evaluated the serial cross-sectional images of the macula obtained using the Spectralis OCT (HRA + OCT; Heidelberg Engineering) in 100 eyes of 94 patients attending a single center and undergoing treatment with intravitreal ranibizumab for neovascular age-related macular degeneration. The baseline OCT characteristics and visual acuity were correlated to the final visual acuity (Early Treatment Diabetic Retinopathy Study letters) and change in visual acuity after, 12 months of monitoring and treatment. Univariate and multivariate analyses were carried out to correlate these morphologic features with the final visual acuity and the change in visual acuity. RESULTS: Intact ellipsoid zone (P = .0001) and external limiting membrane in the subfoveal area (P < .0001) at baseline were the only 2 independent good prognostic indicators of final visual acuity at 12 months. However, none of the morphologic features at baseline could predict the change in visual acuity by 12 months. CONCLUSIONS: The results suggest that integrity of the outer retinal layers at baseline is crucial for determining final visual acuity at 12 months in eyes undergoing treatment with ranibizumab for neovascular age-related macular degeneration. (Am J Ophthalmol 2013;155:720-726. (C) 2013 by Elsevier Inc. All rights reserved.)