Transcript 35 mm - University of Pennsylvania

Baseline Predictors for One Year
Visual Outcomes with Ranibizumab
or Bevacizumab for Neovascular
Age-related Macular Degeneration
Ying G-S, Maguire MG, Jaffe GJ, Grunwald JE, Toth C, Daniel E,
Klein M, Pieramici D, Wells J, Martin DF
for the CATT Research Group
Available through
http://www.med.upenn.edu/cpob/publications_main.shtml
Supported by Cooperative Agreements from the National
Eye Institute, National Institutes of Health, DHHS
1
Age
Mean VA (SE)
Snellen
Mean VA Change (SE)
15
P-value: 0.0004
P-value: 0.002
20/32 75
20/50 65
20/80 55
10
72
69
66
67
5
11
8
6
6
80-89
90
20/125 45
72
20/200 35
50-69
Letters (n=131)
70-79
(n=387)
0
90
(n=75)
80-89
(n=512)
60
67
66
69
50-69
70-79
% of ≥3-lines Gain
P-value: 0.008
50
40
30
20
39%
28%
28%
28%
50-69
70-79
80-89
37%
10
0
90
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Baseline VA in Study Eye
Mean VA Change (SE)
Mean VA (SE)
Snellen
20/32 75
20/50
65
20/80
55
15
P-value: 0.0001
P-value: <0.0001
10
76
59
69
5
8
20/125 45
72
20/200 35
25-40
Letters (n=397)
50-80
(n=414)
41
100-160
(n=223)
200-320
(n=75)
20/X
0
25-40
% of ≥3-lines Gain
60
8
67
663
69
12
50-80
100-160
200-320
P-value: <0.0001
50
40
30
36%
20
53%
42%
10
7%
0
25-40
50-80
100-160
200-320 20/X
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
20/X
Baseline VA in Fellow Eye
% of ≥3-lines Gain
60
P-value: 0.005
50
40
30
20
33%
31%
24%
10
0 20/20 or better
(n=331)
20/25-20/40
(n=433)
20/50 or worse
(n=341)
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Baseline IOP
Mean VA (SE)
Snellen
20/32 75
Mean VA Change (SE)
15
P-value: 0.002
20/50 65
P-value: 0.02
10
72
20/80 55
11
64
68
69
62
67
66
5
8
20/125 45
20/200 35
Letters
<10
(n=27)
10-20
(n=1017)
>20
(n=61)
0
4
8
3
<10
10-20
>20
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
mmHg
Baseline CNV Area
Mean VA Change (SE)
Mean VA (SE)
Snellen
20/32 75
15
P-value: 0.001
P-value: 0.02
20/50 65
20/80 55
10
70
67
68
65
5
9
20/125 45
72
20/200 35
1
Letters (n=443)
>1 to 2
(n=219)
>2 to 
(n=207)
8
0
>4
DA
(n=103)
4
67
66
69
7
1
>1 to 2
>2 to 
>4
% of ≥3-lines Gain
60
P-value: 0.04
50
40
30
20
33%
29%
1
>1 to 2
31%
23%
10
0
>2 to 
>4
DA
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
DA
Lesion Type
Mean VA (SE)
Snellen
20/32 75
P-value: 0.0003
20/50 65
20/80 55
66
68
67
69
20/125 45
20/200 35
Predominantly or Minimally Occult only
Letters
(n=650)
Classic (n=431)
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
RAP Lesion
% of ≥3-lines Gain
Mean VA Change (SE)
60
15
P-value: 0.006
P-value: 0.03
50
40
10
72
69
30
67
66
20
5
7
29%
10
41%
10
0
0
No (n=966)
Yes (n=118)
No
Yes
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Baseline Geographic Atrophy
Mean VA (SE)
Snellen
20/32 75
20/50
65
20/80
55
P-value: 0.01
68
64
20/125 45
20/200 35
Letters
No (n=1027)
Yes (n=76)
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Baseline Foveal Thickness
% of ≥3-lines Gain
Mean VA (SE)
Snellen
20/32 75
60
P-value: 0.02
P-value: 0.004
50
20/50 65
40
72
69
20/80 55
20/125 45
69
70
68
8
67
66
30
66
20
6
10
20/200 35
325 >325-425 >425-550 >550
Letters (n=277) (n=285) (n=253)
(n=285)

0
21%
325
33%
33%
>325-425 >425-550
31%
>550
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Baseline RPE Elevation
Mean VA (SE)
Snellen
20/32 75
20/50
65
20/80
55
Mean VA Change (SE)
15
P-value: 0.006
P-value: 0.005
10
71
68
5
11
20/125 45
72
20/200 35
Letters
No (n=145)
69
60
67
66
0
Yes (n=944)
7
No
Yes
% of ≥3-lines Gain
P-value: 0.002
50
40
30
20
42%
27%
No
Yes
10
0
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Conclusions
Early treatment before VA is profoundly affected will
achieve the best VA outcomes
Baseline VA
VA at 1 Year
Change in VA at 1 Year
Mean (SE) P-value
Mean(SE)
<0.0001
P-value
<0.0001
20/25 - 20/40
76.4 (0.8)
3.3 (0.7)
20/50 - 20/80
69.2 (0.7)
8.4 (0.7)
20/100 – 20/160
59.1 (1.0)
12.0 (1.0)
20/200 - 20/320
41.3 (1.8)
7.6 (1.7)
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
12
Conclusions
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
Conclusions

Baseline predictors of one year VA outcomes are:
Baseline Predictor
Older Age
Worse VA - study eye
Larger CNV Area
RPE elevation
Abnormal IOP
> Foveal thickness
VA score
↓
↓
↓
↓
↓
↓
↑
↓
↓
↓
Inverted U
Thin ↓
GA
≥3-lines gain
↑
RAP lesion
Any classic
VA Change
U
↑
↓
↓
↑
↓
↓
Worse VA - fellow eye
Ying et al. Baseline Predictors for 1 yr. visual outcomes with ranibizumab or bevacizumab for neovascular AMD Ophthalmology 2013;120:122-129
↓