Denmark: A research article published in Acta Ophthalmologica, a study has demonstrated that retinal venular vasculature may predict the initial treatment response to intravitreal therapy. If the visual and functional prognosis of nAMD patients can be categorized before initiating treatment, then it is possible to provide a personalized treatment regimen.
Prediction of the early treatment response is crucial in neovascular age-related macular degeneration (nAMD).
Researchers in the present study tested whether non-invasive measurements of the retinal vascular structure predict initial intravitreal treatment outcomes.
They included 58 eyes (58 patients) with treatment-naïve nAMD. Using Singapore I Vessel Assessment, they measured advanced markers of the retinal vascular structure before starting intravitreal treatment, which included three monthly injections of aflibercept.
They categorized the patients as full treatment responders (FTR) or non/partial treatment responders (N/PR).
The results of this research article are summarised below:
In 54 eyes with follow-up, 44.4% were categorized as FTR. These patients were older (81.5 vs 77 years and before treatment, their eyes had a lower retinal arteriolar fractal dimension (Fd) (1.21 vs 1.24 units) and venular length-diameter ratio (LDR) (7.3 vs 15.9 units).
These did not differ regarding other retinal vascular parameters.
A higher retinal venular LDR independently predicted a lower chance of FTR and marginally by a higher retinal arteriolar Fd.
They said, “Retinal venular LDR independently predicted the initial treatment response in nAMD. This can guide treatment If confirmed by long-term studies.
The study strengths include prospective design, validated retinal structural measurements, and the inclusion of a treatment-naïve cohort.
The limitations include a limited number of patients and a lack of data on the subtypes of macular neovascularization, so we recommend more long-term studies to determine precision and validity.
Further reading:
Leth-Møller Christensen K, Kristjansen DB, Vergmann AS, Torp TL, Peto T, Grauslund J. Retinal vascular structure independently predicts the initial treatment response in neovascular age-related macular degeneration. Acta Ophthalmol. 2023 May 17. doi: 10.1111/aos.15709.