Article
Subjective treatment success and subjective recurrence detection after ranibizumab treatment in exsudative AMD
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Published: | June 15, 2011 |
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Background: Ranibizumab therapy of exsudative AMD is cost intensive and invasive. European drug approval requires time intense follow-ups for justification of retreatment upon recurrence of choroidal neovascularization (CNV). We have studied whether 1.) ranibizumab therapy resulted in clinically relevant improvement for the patient, and 2.) have tested the sensitivity of patient self control, Amsler grid, visual acuity assessment, fundus examination and SD-OCT in detecting CNV recurrence.
Methods: ETDRS visual acuity (VA), Radner reading VA, reading speed (words per minute, wpm), Amsler, subjective impression, funduscopy and SD-OCT were performed in 74 patients before and after initial ranibizumab treatment series. Objective and subjective functional changes were correlated. After CNV involution, monthly controls were conducted in 40 patients. Upon appearance of SD-OCT-confirmed novel fluid, classified as morphologic recurrence, sensitivity of objective and subjective functional deterioration were compared to OCT.
Results: ETDRS VA improved from 55+13.6, gaining 3.2+12.0 (p=0.026), reading speed of 54+26 wpm gained 20.7+44 wpm (p<0.001). 68% (n=50) of patients perceived improvement, 21% (n=16) no change and 11% (n=8) deterioration. Subjective impression and objective functions correlated for each group (p=0.002, p<0.001, p=0.043). Regression analysis confirmed correlation between objective VA change and subjective perception (p=0.001). Subjective perception was independent of better or worse eye treated (p=0.826). Proportion of recurrence detection compared to 40 OCT-morphologic recurrences (100%): subjective deterioration 6 (15%); increase of metamorphopsia 12 (30%); ETDRS- and/or Radner VA loss of > one line 11 (28%); funduscopic 10 (25%); cumulative sensitivity 27 (67.5%).
Conclusion: Ranibizumab treatment success in AMD is not only statistically significant, but despite intensity and invasiveness clinically relevant for the patient. Regarding recurrence detection, SD-OCT outclasses all other psycho/physic examination methods. Morphologic recurrences can be detected prior to functional deterioration.