Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials

Alex S Willoughby; Gui-Shuang Ying; Cynthia A Toth; Maureen G Maguire; Russell E Burns; Juan E Grunwald; Ebenezer Daniel; Glenn J Jaffe; Comparison of Age-Related Macular Degeneration Treatments Trials Research Group

doi:10.1016/j.ophtha.2015.05.042

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Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials

Journal article

Peer reviewed

Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials

Alex S Willoughby, Gui-Shuang Ying, Cynthia A Toth, Maureen G Maguire, Russell E Burns, Juan E Grunwald, Ebenezer Daniel, Glenn J Jaffe and Comparison of Age-Related Macular Degeneration Treatments Trials Research Group

Ophthalmology (Rochester, Minn.), Vol.122(9), pp.1846-1853.e5

09/2015

DOI: 10.1016/j.ophtha.2015.05.042

PMCID: PMC4549177

PMID: 26143666

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https://www.ncbi.nlm.nih.gov/pmc/articles/4549177View

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Abstract

To evaluate the association of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA), and scar in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Prospective cohort study within a randomized clinical trial. The 1185 CATT participants. Masked readers graded scar and GA on fundus photography and fluorescein angiography and graded SHRM on time-domain and spectral-domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1 mm(2), or outside the center 1mm(2) were obtained on SD OCT images at 56 (n = 76) and 104 (n = 66) weeks. Presence of SHRM, as well as location and size, and associations with VA, scar, and GA. Among CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and to 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved (64% vs. 31%; P < 0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n = 76) and 104 (n = 66), mean VA letter score was 73.5 (standard error [SE], 2.8), 73.1 (SE, 3.4), 65.3 (SE, 3.5), and 63.9 (SE, 3.7) when SHRM was absent, present outside the central 1 mm(2), present within the central 1 mm(2) but not the foveal center, or present at the foveal center (P = 0.02), respectively. When SHRM was present, the median maximum height under the fovea, within the central 1 mm(2) including the fovea and anywhere within the scan, was 86 μm, 120 μm, and 122 μm, respectively. Visual acuity was decreased with greater SHRM height and width (P < 0.05). In eyes with neovascular age-related macular degeneration (AMD), SHRM is common and often persists after anti-vascular endothelial growth factor treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM dimensions were associated with worse VA. In eyes with neovascular AMD, SHRM is an important morphologic biomarker.

Antibodies, Monoclonal, Humanized - therapeutic use

Prospective Studies

Intravitreal Injections

Tomography, Optical Coherence

Humans

Middle Aged

Geographic Atrophy - physiopathology

Cicatrix - diagnosis

Vascular Endothelial Growth Factor A - antagonists & inhibitors

Bevacizumab

Retinal Pigment Epithelium

Wet Macular Degeneration - drug therapy

Ranibizumab

Angiogenesis Inhibitors - therapeutic use

Retina - pathology

Visual Acuity - physiology

Fluorescein Angiography

Details

Title: Subtitle: Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials
Creators: Alex S Willoughby - Department of Ophthalmology, Duke University, Durham, North Carolina
Gui-Shuang Ying - Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Cynthia A Toth - Department of Ophthalmology, Duke University, Durham, North Carolina
Maureen G Maguire - Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Russell E Burns - Duke Reading Center, Durham, North Carolina
Juan E Grunwald - Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Ebenezer Daniel - Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Glenn J Jaffe - Department of Ophthalmology, Duke University, Durham, North Carolina. Electronic address: glenn.jaffe@dm.duke.edu
Comparison of Age-Related Macular Degeneration Treatments Trials Research Group
Contributors: James C Folk (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Douglas B Critser (Contributor) - University of Iowa, The University of Iowa Institute for Vision Research
Stephen R Russell (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Heather A Stockman (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Resource Type: Journal article
Publication Details: Ophthalmology (Rochester, Minn.), Vol.122(9), pp.1846-1853.e5
DOI: 10.1016/j.ophtha.2015.05.042
PMID: 26143666
PMCID: PMC4549177
NLM abbreviation: Ophthalmology
ISSN: 0161-6420
eISSN: 1549-4713
Publisher: United States
Grant note: U10EY017825 / NEI NIH HHS U10 EY017825 / NEI NIH HHS R21EY023689 / NEI NIH HHS U10EY017828 / NEI NIH HHS
Language: English
Date published: 09/2015
Academic Unit: The University of Iowa Institute for Vision Research; Ophthalmology and Visual Sciences
Record Identifier: 9983979944002771

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