Three-Dimensional Analysis of Morphologic Changes and Visual Outcomes in Neovascular Age-Related Macular Degeneration

To investigate the association of three-dimensionally quantified lesions with best-corrected visual acuity (BCVA) in typical neovascular age-related macular degeneration (nAMD).

We retrospectively analyzed 65 eyes of 61 typical nAMD patients. Lesions at baseline and month 12 were manually delineated in optical coherence tomography. The volume of intraretinal fluid (IRF), subretinal fluid (SRF), subretinal hyperreflective material (SHRM), and pigment epithelial detachment (PED) were measured. In addition, the areas of external limiting membrane (ELM) and ellipsoid zone (EZ) were calculated.

At baseline, poor baseline BCVA was associated with increased volume of IRF and SHRM and impaired area of ELM (β = 0.34, P = 0.001; β = 0.46, P < 0.001; and β = -0.23, P = 0.03, respectively). At month 12, poor BCVA was associated with increased volume of IRF, reduced intact ELM area, and decreased EZ area (β = 0.24, P = 0.01; β = -0.30, P = 0.02; and β = -0.37, P = 0.004, respectively). Baseline BCVA, volume of IRF, and intact area of ELM were significant predictors for BCVA at month 12 (β = 0.29, P = 0.01; β = 0.30, P = 0.01; and β = -0.28, P = 0.01). Changes of BCVA were associated with changes of SHRM volume, intact EZ area, and ELM area (β = 0.35, P = 0.002; β = -0.28, P = 0.01; and β = -0.22, P = 0.048, respectively). The predictive power of volumetric analysis was higher than that of qualitative analysis (R2 = 0.47 vs. R2 = 0.37). The volume of SRF and fibrovascular PED showed positive and negative effect on visual outcome each, but they were not strong enough to remain in multivariate model.

Best-corrected visual acuity could be explained by three-dimensional optical coherence tomography morphology to a fair degree. In addition, three-dimensional analysis could predict visual outcomes better than qualitative analysis.