Long-Term Predictive Value of Macular Thickness Fluctuations in Response to Anti-VEGF Treatment for Age-Related Macular Degeneration

Purpose: To evaluate whether macular thickness fluctuations are predictive of long-term visual outcomes in patients with neovascular age-related macular degeneration (nAMD) after treatment initiation with antivascular endothelial growth factor (anti-VEGF). Methods: Patients with nAMD treated with anti-VEGF intravitreal injections for 3 and 5 years were evaluated. Anatomic parameters, including central subfield thickness (CST), were evaluated with optical coherence tomography. The cohort was segregated into quartiles based on CST variability over the initial 12 months of treatment. Kruskal-Wallis tests were used to compare 3- and 5-year final best-corrected visual acuity (BCVA), change in BCVA, final CST, and change in CST among quartiles. Multiple linear regression analyses were subsequently performed. Results: Three hundred sixty-six eyes were included in the 3-year analysis and 275 eyes in the 5-year analysis. Patients received an average of 8.4 injections over 12 months and had a final mean BCVA of 60.7 Early Treatment Diabetic Retinopathy Study letters. Those with the greatest CST variability demonstrated significantly lower baseline and final BCVA compared with other quartiles, alongside lower baseline BCVA values. No difference was found between quartiles for final CST and change in BCVA. Multiple linear regression analyses demonstrated that macular thickness variability characterized by the standard deviation of CST, baseline VA, and age was a significant predictor of VA after 3 and 5 years. Conclusions: Macular thickness variability was a statistically significant correlate and limited predictor of long-term response to visual outcomes at 3 and 5 years after anti-VEGF initiation. Macular thickness variability may be a biomarker with limited long-term predictive value in patients with nAMD.