OCT biomarkers may predict visual outcomes in nAMD treatment

(Image Credit: AdobeStock/Rabizo Anatolii)

An international study led by Hamid Riazi-Esfahani, MD, found that the presence of biomarkers observed on optical coherence tomography (OCT) images at baseline may help predict changes in the visual acuity (VA) of patients with neovascular age-related macular degeneration (nAMD) who underwent treatment with aflibercept (Eylea, Regeneron Pharmaceuticals). He is from the Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

While the use of OCT biomarkers for diagnosing and monitoring nAMD has been reported,² the current predictive ability is limited. Riazi-Esfahani and colleagues have taken their research a step further by evaluating a comprehensive set of baseline OCT biomarkers in treatment-naïve patients with nAMD to determine this approach’s ability to better predict VA changes after aflibercept treatment. This knowledge facilitates individualized monitoring of treatment response in patients, which allows switching to another therapy and adjustments in treatment intervals.

The investigators conducted a retrospective study of treatment-naïve patients aged 50 years and older, all of whom had undergone examinations and were diagnosed with macular neovascularization (MNV) with intraretinal and/or subretinal fluid or hemorrhage and drusen. The patients had 1 focus of MNV with either type 1 or mixed type 1 and type 2 MNV.

The investigators evaluated baseline OCT biomarkers, ie, shallow irregular pigment epithelial detachment, subretinal hyperreflective material, subretinal fluid, intraretinal fluid, hyperreflective foci, and subretinal drusenoid deposits. They also measured the maximal height and width of the largest pigment epithelial detachment.

Treatment included bimonthly aflibercept injections after 3 loading doses. The VAs were evaluated at 3 and 12 months.

The study included 89 eyes with nAMD. The results showed that the mean best-corrected VA (BCVA) improved by 6 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline to month 3, with sustained improvement seen through month 12, the authors reported.

The presence of baseline intraretinal fluid was associated with less VA improvement at month 12; the presence of baseline intraretinal fluid was associated with a mean improvement of 1.6 ± 18.2 ETDRS letters compared with 11.1 ± 10 ETDRS letters in eyes that did not have baseline intraretinal fluid (P = 0.002).

Multivariable analysis found that lower VA improvements were associated with the presence of a shallow irregular pigment epithelial detachment at month 3 (P = 0.025). The widest pigment epithelial detachment was correlated significantly with lower BCVA gains at months 3 (P = 0.021) and 12 (P = 0.043), suggesting its potential as a prognostic factor.

The investigators concluded, “Our study highlights the significance of baseline OCT biomarkers like intraretinal fluid, shallow irregular pigment epithelial detachment, and wide pigment epithelial detachment in predicting visual gains in treatment-naïve patients with nAMD. Further prospective studies are warranted to validate these findings and explore additional predictors of treatment response, ultimately enhancing the management of this sight-threatening condition.”

References

1. Riazi-Esfahani H, Faghihi H, Bazvand F, et al.Predictive value of different baseline optical coherence tomography biomarkers for visual acuity changes in neovascular age-related macular degeneration.Int J Retin Vitr. 2025;11:12; https://doi.org/10.1186/s40942-025-00633-0

2. Nawash B, Ong J, Driban M, et al. Prognostic optical coherence tomography biomarkers in neovascular age-related macular degeneration. J Clin Med. 2023;12:3049. https://doi.org/10.3390/jcm12093049.