TY - JOUR
T1 - Natural History of Predominantly Classic, Minimally Classic, and Occult Subgroups in Exudative Age-related Macular Degeneration
AU - Shah, Ankoor R.
AU - Del Priore, Lucian V.
PY - 2009/10
Y1 - 2009/10
N2 - Objectives: We previously showed that the pattern of vision loss in eyes with subfoveal neovascularization in age-related macular degeneration (AMD) is uniform across a wide range of clinical trials, with apparent differences arising from differences in the time of entry of patients into clinical trials. In the current study, we used a similar analysis to compare the visual loss of untreated control eyes classified as predominantly classic (PC), minimally classic (MC), and occult with no classic (occult) based on fluorescein angiography. Design: Meta-analysis of prior clinical trials. Participants: Data from patients enrolled in the Macular Photocoagulation Study (MPS), Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study, Verteporfin in Photodynamic Therapy (VIP) Study, Anecortave Acetate (AA) Trial, VEGF Inhibition Study in Ocular Neovascularization (VISION), and Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular Age-Related Macular Degeneration (MARINA) Trials. Methods: Visual acuity (VA) data of untreated control eyes for each study from appropriate subgroups were plotted on a double reciprocal (Lineweaver-Burke) plot of 1/[letters lost] versus 1/[months]. To correct for differences in time of entry into clinical trials, we introduced a horizontal translation factor to shift each data subset. Main Outcome Measures: We determined the coefficient of determination before and after adjustments for visual acuity at the time of enrollment. Results: On a Lineweaver-Burke plot, the cumulative subgroups had an overall coefficient of determination of only r2<0.01 for the raw data but improved to a remarkably high r2 = 0.90 when data were corrected for time of entry into clinical trials. For each subgroup there was excellent correlation between 1/[letters lost] versus 1/[months of exudative disease] for PC (r2 = 0.91), MC (r2 = 0.95), and occult (r2 = 0.98) choroidal neovascularization. Conclusions: We were able to demonstrate a strong correlation for visual acuity as a function of time that is independent of the fluorescein angiography classification of a lesion, suggesting that initial protocol visual acuity, rather than angiographic classification, is the major determinant of the behavior of visual acuity as a function of time in exudative AMD. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
AB - Objectives: We previously showed that the pattern of vision loss in eyes with subfoveal neovascularization in age-related macular degeneration (AMD) is uniform across a wide range of clinical trials, with apparent differences arising from differences in the time of entry of patients into clinical trials. In the current study, we used a similar analysis to compare the visual loss of untreated control eyes classified as predominantly classic (PC), minimally classic (MC), and occult with no classic (occult) based on fluorescein angiography. Design: Meta-analysis of prior clinical trials. Participants: Data from patients enrolled in the Macular Photocoagulation Study (MPS), Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study, Verteporfin in Photodynamic Therapy (VIP) Study, Anecortave Acetate (AA) Trial, VEGF Inhibition Study in Ocular Neovascularization (VISION), and Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular Age-Related Macular Degeneration (MARINA) Trials. Methods: Visual acuity (VA) data of untreated control eyes for each study from appropriate subgroups were plotted on a double reciprocal (Lineweaver-Burke) plot of 1/[letters lost] versus 1/[months]. To correct for differences in time of entry into clinical trials, we introduced a horizontal translation factor to shift each data subset. Main Outcome Measures: We determined the coefficient of determination before and after adjustments for visual acuity at the time of enrollment. Results: On a Lineweaver-Burke plot, the cumulative subgroups had an overall coefficient of determination of only r2<0.01 for the raw data but improved to a remarkably high r2 = 0.90 when data were corrected for time of entry into clinical trials. For each subgroup there was excellent correlation between 1/[letters lost] versus 1/[months of exudative disease] for PC (r2 = 0.91), MC (r2 = 0.95), and occult (r2 = 0.98) choroidal neovascularization. Conclusions: We were able to demonstrate a strong correlation for visual acuity as a function of time that is independent of the fluorescein angiography classification of a lesion, suggesting that initial protocol visual acuity, rather than angiographic classification, is the major determinant of the behavior of visual acuity as a function of time in exudative AMD. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
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U2 - 10.1016/j.ophtha.2009.03.055
DO - 10.1016/j.ophtha.2009.03.055
M3 - Article
C2 - 19592101
AN - SCOPUS:70349469705
SN - 0161-6420
VL - 116
SP - 1901
EP - 1907
JO - Ophthalmology
JF - Ophthalmology
IS - 10
ER -