Area of retinal nonperfusion correlated with BCVA, CRT improvement

ByRobert Linnehan

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A post hoc analysis of a subset of patients with diabetic macular edema treated with an anti-VEGF agent in the VISTA phase 3 trial identified a moderate correlation between significant reductions in macular retinal nonperfusion with improvements in best corrected visual acuity and central retinal thickness, according to a presenter at the virtual Association for Research in Vision and Ophthalmology meeting.

“For best corrected visual acuity, there was a moderate negative correlation. As BCVA increased, retinal nonperfusion area decreased among aflibercept-treated eyes. Similarly, for central subfield thickness, there was a moderate positive correlation. That is, as central subfield thickness decreased, retinal nonperfusion decreased among aflibercept-treated eyes,” Charles C. Wykoff, MD, said.

Wykoff and colleagues included 178 of 466 eyes from the VISTA study in their analysis. Eyes had available fluorescein angiography images at baseline and weeks 52 and 100, with quantifiable retinal nonperfusion (RNP). Sixty eyes were treated with intravitreal aflibercept 2 mg injections every 4 weeks (2q4), 55 eyes were treated with intravitreal aflibercept 2 mg injections every 8 weeks (2q8) following five monthly doses, and 63 eyes were treated with laser therapy. Wykoff and colleagues evaluated the relationship between macular RNP area and visual and anatomic outcomes, as well as baseline RNP, on the incidence of proliferative diabetic retinopathy (PDR) through 2 years.

At baseline, the RNP area was 1.7 mm² for 2q4 eyes, 1.5 mm² for 2q8 eyes and 1.5 mm² for laser eyes. By week 100, the mean change from baseline in RNP area was a 0.7 mm² reduction for 2q4 eyes, a 0.6 mm² reduction for 2q8 eyes and a 0.2 mm² reduction for laser eyes, with the reductions correlating with BCVA improvements for 2q4 and 2q8 eyes (P < .05) and central retinal thickness improvements (P < .05) . There was no correlation with the laser control group, Wykoff said.

Wykoff and colleagues found the extent of baseline RNP was also associated with an increased risk for development of PDR. Compared with eyes with a baseline RNP of 0.615 mm² or less, eyes with baseline RNP areas between 0.615 mm² and 1.255 mm² or less experienced PDR events 2.1 times more frequently. Additionally, eyes with baseline RNP areas greater than 1.255 mm² experienced PDR events 9.2 times more frequently. – by Robert Linnehan

Reference:

Wykoff CC. Retinal nonperfusion (RNP) extent and its relationship with visual, anatomic and disease state outcomes among eyes treated for diabetic macular edema (DME). Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 6, 2020 (virtual meeting).

Disclosure: Wykoff reports he is a consultant for and receives financial compensation from Adverum, Allergan, Genentech/Roche, Novartis, Regeneron and Regenxbio and is a consultant for Alimera, Bayer and Takeda.