Association of changes in optical coherence tomography metrics with changes in refractive error in patients with neovascular age-related macular degeneration in the CATT.

OBJECTIVE

Assess the change in refractive error (RE) in patients receiving anti-vascular endothelial growth factor (VEGF) therapy for exudative age-related macular degeneration.

METHODS

Post hoc analysis of data from the Comparison of AMD Treatments Trials (CATT). Associations between spherical equivalent (SphE) change and optical coherence tomography (OCT) metrics were evaluated using correlation coefficients (r) and regression analyses stratified by baseline lens status.

RESULTS

Analysis included 1 171 patients with OCT fluid in the study eye at baseline. The mean (± SD) of SphE shifted toward myopia in study eyes from 0.62 ± 1.63 diopters (D) at baseline to 0.50 ± 1.61 D at 2 years (p < 0.0001). Phakic study eyes had larger myopic shifts than pseudophakic eyes at 2 years (-0.19 ± 0.97 D vs -0.06 ± 0.90 D; p = 0.03). In phakic study eyes, the RE change was significantly correlated with change in subretinal thickness (Spearman r = 0.21; p < 0.0001), subretinal tissue complex (r = 0.12; p = 0.01), and total thickness (r = 0.36; p < 0.0001). A myopic shift greater than 1.0 D occurred in 74 (7.0%) and 104 (10.2%) study eyes at years 1 and 2, respectively.

CONCLUSION

Among CATT participants, the RE of study eyes shifted toward myopia at 2 years with phakic eyes having larger shifts. OCT metric changes were weakly correlated with changes in RE, suggesting that drying of the macula with anti-VEGF therapy may have a minor impact on RE. Still, 10% of patients may develop a 1 D myopic shift at 2 years, typically in those with more baseline fluid. Patients with neovascular AMD may be able to update their spectacles, even if macular edema is present, as the change in RE is negligible when drying the macula.