Macular thickness fluctuation in neovascular age-related macular degeneration treated with anti- vascular endothelial growth factor

Objective: To establish whether increased variability in macular thickness in neovascular age-related macular degeneration (nAMD) patients affects visual outcomes in clinical practice Design: Retrospective cohort study Participants: Treatment-naive nAMD patients studied over 24 months Methods: Central subfield thickness (CST) values from optical coherence tomography were collected quarterly from baseline to 24 months, and standard deviations (SDs) were calculated. The relationship was modeled with mixed-effects regression between CST SD and 24-month change in visual acuity (VA). Linear regression modeling determined predictors of CST SD. Results: A total of 422 eyes with nAMD were studied. Baseline and 24-month CST values (mean +/- SD) were 331.2 +/- 97.6 and 253.4 +/- 53.6 mu m (D =-77.8 +/- 104.7 mu m, p < 0.001), with CST SD across 24 months of 42.0 +/- 32.8 mu m. Baseline and 24-month VA were 58.8 +/- 19.2 and 62.4 +/- 20.6 Early Treatment of Diabetic Retinopathy Study letters (D = +3.7 +/- 20.8 letters, p = 0.008). CST SD over 24 months was a statistically significant negative predictor of 24-month change in VA (-15.41 [-20.98,-9.83] letters per 100 mu m, p < 0.001). Quartile analysis of 24-month VA by CST SD showed a +11.2-letter difference between the first and last quartiles (p < 0.001). Baseline CST was a predictor of 24-month CST SD (24.88 [22.69, 27.06] mu m per 100 mu m, p < 0.001). Conclusions: Higher macular thickness fluctuations are related to poorer visual outcomes at 24 months in patients with nAMD treated with anti-vascular endothelial growth factor injections. Macular thickness variability may be an important prognostic factor of visual outcomes in nAMD eyes.