Association between anatomical and clinical outcomes of neovascular age-related macular degeneration treated with anti-VEGF

PURPOSE Assess the relationship between subretinal fluid (SRFL), intraretinal fluid (IRFL), and visual outcomes of neovascular age-related degeneration (nAMD) in routine clinical practice. METHODS Treatment-naive eyes enrolled in the Fight Retinal Blindness! registry after Jan-2017 were identified. Lesion activity was graded at each visit as inactive, active not SRFL only (A-NSRFL only), or active SRFL only (A-SRFL only). Eyes were grouped based on initial activity: 1) initially A-NSRFL only or 2) initially A-SRFL only, and their predominant activity status over 12 months: 1) mostly inactive, 2) mostly A-NSRFL only or 3) mostly A-SRFL only. RESULTS 703 eyes were eligible for analysis. Initially A-NSRFL only had similar adjusted mean 12-month VA change to initially A-SRFL eyes (5.7 vs. 6.9 letters; P=0.165) but their final VA was worse (62.5 vs. 67.5 letters at 12 months; P=0.003). Adjusted mean 12-month VA change between the predominant activity groups was significantly different (P=0.005), with mostly inactive (7.6 letters) and mostly A-SRFL only (7.5 letters) eyes gaining more than mostly A-NSRFL only eyes (3.6 letters). CONCLUSIONS Eyes with SRFL only had similar outcomes at 1 year to eyes that were mostly inactive. Intraretinal fluid was associated with worse visual outcomes, highlighting the importance of distinguishing between IRFL and SRFL when managing nAMD.