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Novel Photoacoustic Microscopy and Optical Coherence Tomography Dual-modality Chorioretinal Imaging in Living Rabbit Eyes
Published on: February 8, 2018
Novel volumetric imaging biomarkers for assessing disease activity in eyes with PCV
Chinmayi Himanshuroy Vyas1, Chui Ming Gemmy Cheung1,2, Janice Marie N Jordan-Yu1
1Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
Abstract:
The aim of this study was to evaluate influence of baseline imaging features on visual and anatomical outcomes in eyes with PCV treated with anti-VEGF monotherapy. In this prospective study we enrolled participants with treatment-naïve PCV who followed a treat-and-extend protocol using intravitreal aflibercept (IVA) monotherapy. Baseline clinical features evaluatedincluded best corrected visual acuity (BCVA), traditional features such as lesion size, fluid-related OCT parameters and novel parameters using automated software. This included quantitative and qualitative pigment epithelium detachment (PED) parameters [height, volume]; and choroidal parameters. [choroidal thickness (CT), choroidal volume (CV) and choroidal vascularity index (CVI). We evaluated the predictive value of each parameter on visual and anatomical outcome at month 12. We additionally evaluated initial treatment response after 3 monthly injections with respect to month 12 outcomes. Fifty-two eyes from 52 participants were included in the study. The BCVA increased from 61.1 ± 13.2 to 69.6 ± 13.2 early treatment diabetic retinopathy study (ETDRS) letters (p < 0.01) and CRT reduced from 455.7 ± 182.4 µm to 272.7 ± 86.2 (p < 0.01) from baseline to month 12. The proportion of eyes with PED decreased significant from 100% at baseline to 80% at month 12 (p < 0.01). Reduction in the mean maximum height of PED (from 381.3 ± 236.3 µm to 206.8 vs ± 146.4 µm) and PED volume (from 1322 ± 853 nl to 686 ± 593 nl) (p < 0.01) was also noted from baseline to month12. Baseline features associated with better month 12 BCVA included baseline BCVA (β = - 0.98, 95%CI - 3.38 to - 1.61, p = 0.02) and baseline CRT (β = - 0.98, 95%CI - 1.56 to - 0.40, p = 0.04) while the disease activity at month12 was significantly associated with lower baseline CRT (366.0 ± 129.5 vs 612.0 ± 188.0 , p < 0.001), lower baseline PED height (242.0 ± 150.0 vs 542.0 ± 298.0 µm, p < 0.01), lower baseline PED volume (0.6 ± 0.3 mm3 vs 2.2 ± 1.3 mm3 vs, p < 0.01), lower proportion with marked CVH (17.9% vs 46.2%, p = 0.02) and lower mean CVI (61.8 ± 1.4 vs 63.0 ± 1.4, p < 0.02). Additionally, a larger decrease in CRT (per 100 nm) and larger PED volume reduction (per 100 nl) at month 3 from baseline were associated with greater BCVA gain and inactive disease. PED-related volumetric parameters have an additional predictive value to traditional biomarkers of disease activity in eyes with PCV undergoing anti-VEGF monotherapy. With increasingly precise quantification, PEDs can be a crucial biomarker in addition to traditional parameters and may aid in retreatment decisions.
Insights
This study found that baseline imaging features, particularly pigment epithelium detachment (PED) volume, predict visual and anatomical outcomes in polypoidal choroidal vasculopathy (PCV) eyes treated with anti-VEGF therapy. These findings suggest PED can be a key biomarker for treatment decisions.
Area of Science:
- Ophthalmology
- Medical Imaging
- Retinal Diseases
Background:
- Polypoidal choroidal vasculopathy (PCV) is a common cause of vision loss.
- Anti-VEGF monotherapy is a standard treatment for PCV.
- Predicting treatment response is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate how baseline imaging features influence visual and anatomical outcomes in PCV eyes treated with anti-VEGF monotherapy.
- To assess the predictive value of traditional and novel imaging parameters on treatment response at 12 months.
- To determine if early treatment response predicts long-term outcomes.
Main Methods:
- Prospective study of 52 treatment-naïve PCV patients on intravitreal aflibercept (IVA) monotherapy.
- Evaluation of baseline best-corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters (e.g., CRT, PED height/volume), and choroidal parameters (CT, CV, CVI).
- Analysis of predictive value of baseline features and early treatment response (3 months) on month 12 outcomes.
Main Results:
- Significant improvements in BCVA (p<0.01) and reduced central retinal thickness (CRT) (p<0.01) from baseline to 12 months.
- Reduced PED proportion (p<0.01), height (p<0.01), and volume (p<0.01) at 12 months.
- Lower baseline CRT, PED height, PED volume, and CVI were associated with better month 12 BCVA and less disease activity. Early CRT and PED volume reduction predicted greater BCVA gain.
Conclusions:
- Baseline quantitative PED parameters, such as volume, provide additional predictive value beyond traditional biomarkers for anti-VEGF therapy in PCV.
- Precise quantification of PEDs can serve as a crucial biomarker, aiding in retreatment decisions.
- Imaging features, especially PED-related volumetric parameters, are important for predicting treatment response in PCV.
