Intraretinal Fluid May Predict Poor Visual Outcomes in Wet AMD

The presence of intraretinal fluid is associated with poor visual outcomes in patients with neovascular age-related macular degeneration (wet AMD) treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF), according to a report published in Acta Ophthalmologica.

Researchers conducted a retrospective cohort study of patients with newly diagnosed neovascular AMD with a minimum of 12 months of follow up to assess the association between anatomical outcomes and changes in functional outcome.

The team extracted observational data from a prospectively maintained treatment log, including at baseline (at diagnosis) and month 3, 6, 9, 12, 18 and 24 after the initiation of treatment with anti-VEGF. The study included 1 eye per patient. 

Data included the presence of intraretinal fluid, subretinal fluid, and pigment epithelium detachment, and variability of central retinal thickness (CRT). The primary outcome measure was visual acuity. The researchers evaluated the prognostic effect of the presence or absence of fluid (as intraretinal fluid, subretinal fluid or pigment epithelium detachment) on visual acuity.

A total of 504 treatment-naïve eyes of 504 patients with neovascular AMD were included in the study. The cohort consisted of 63% women and 37% men. Their mean age at onset of neovascular AMD was 80.0±8.2 years. 

The researchers found that the presence of intraretinal fluid was associated with lower visual acuity at all visits (P <.001) but that the presence of subretinal fluid or pigment epithelium detachment was not. They also found that patients with the highest levels of CRT variance showed greater loss in visual acuity at 12 and 24 months (P <.001).

“[W]e find that intraretinal fluid is important to treat aggressively, and stabilization of the central retinal thickness is important to obtain a good visual outcome in neovascular AMD patients,” explain the researchers. “Our study also shows that the presence of subretinal fluid and [pigment epithelium detachment] alone is not associated with loss of visual acuity, indicating that patients with smaller amounts of persistent subretinal fluid and/or [pigment epithelium detachment] that remains stable despite of retreatment and where [visual acuity] is stable might benefit from observation with close monitoring, instead of retreatment.”

Disclosure: This research was supported by Novartis. Please see the original reference for a full list of disclosures.