Impact of Central Subfield Thickness Fluctuations on Visual Outcomes in Neovascular Age-Related Macular Degeneration in the VIEW Trials

<b>Purpose:</b> To evaluate the impact of central subfield thickness (CST) fluctuations on visual outcomes in treatment-naïve eyes with neovascular age-related macular degeneration from VIEW 1 and VIEW 2. <b>Methods:</b> Eyes were treated with intravitreal ranibizumab 0.5 mg every 4 weeks (Rq4) or aflibercept 2 mg every 4 or 8 weeks (2q4 or 2q8). The relationship between CST fluctuations and visual outcomes was evaluated via mixed model for repeated measures in quartiles of SDs of CST from baseline to week 52 (n = 1792; quartile 1: ≤27.6 µm; quartile 2: >27.6 to ≤42.5 µm; quartile 3: >42.5 to ≤65.3 µm; quartile 4: >65.3 µm) and weeks 12 to 52 (n = 1766; quartile 1: ≤27.0 µm; quartile 2: >27.0 to ≤43.2 µm; quartile 3: >43.2 to ≤67.8 µm; quartile 4: >67.8 µm). <b>Results:</b> Least squares mean best-corrected visual acuity (BCVA) gains from baseline to week 52 for quartile 1 to quartile 4 were 9.6, 10.1, 9.6, and 6.7 letters, respectively (quartile 4 vs quartile 1: nominal <i>P</i> = .0017). Least squares mean BCVA letter gains within each quartile treated with Rq4, 2q4, and 2q8, respectively, were 7.0, 10.3, and 10.2 (quartile 1); 11.3, 9.3, and 8.8 (quartile 2); 10.0, 9.3, and 10.1 (quartile 3); and 7.4, 8.4, and 6.2 (quartile 4). From weeks 12 to 52, least squares mean BCVA gains for quartile 1 to quartile 4 were 10.0, 9.7, 9.7, and 6.9 letters, respectively (quartile 4 vs quartile 1: nominal <i>P</i> = .0008). Least squares mean BCVA letter gains within each quartile treated with Rq4, 2q4, and 2q8, respectively, were 7.9, 10.7, and 10.6 (quartile 1); 10.7, 9.3, and 8.1 (quartile 2); 9.3, 9.5, and 10.9 (quartile 3); and 8.2, 8.0, and 6.4 (quartile 4). <b>Conclusions:</b> The highest CST fluctuation was associated with lower BCVA gains, irrespective of antivascular endothelial growth factor agent or regimen.