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Balaskas, Konstantinos MD*,†,‡; Karampelas, Michael MD‡,§; Horani, Mania MD*; Hotu, Oana MD*; Keane, Pearse PhD*,¶; Aslam, Tariq PhD*,†

doi: 10.1097/IAE.0000000000001342
Original Study

Purpose: To assess whether best-corrected visual acuity and pigment epithelial detachment (PED) height, volume, and reflectivity in patients with wet age-related macular degeneration are influenced by baseline anatomical and functional parameters, including quantifiable metrics of PED morphology and choice of treatment.

Methods: One hundred two consecutive, treatment-naive wet age-related macular degeneration patients with PED (>50 μm) treated with aflibercept (52) or ranibizumab (50) were retrospectively included. Pigment epithelial detachment height, horizontal and vertical dimensions, and volume were recorded at baseline, 3 months, and 1 year, respectively. Bespoke image analysis software provided a quantifiable measure of reflectivity.

Results: Best-corrected visual acuity at 3 months was influenced by baseline best-corrected visual acuity (P = 0.006). Pigment epithelial detachment height was influenced by baseline height (P = 0.009), subretinal fluid (P = 0.008), central macular thickness (P = 0.006), and use of aflibercept (P = 0.003) at 3 months and by baseline height (P = 0.018), volume (P = 0.017), vertical dimension (P = 0.0004), and aflibercept (P = 0.015) at 1 year. Pigment epithelial detachment reflectivity increased from 43.59 to 55.86 (3 months) and 57.35 (1 year) (P < 0.001) and was influenced by its baseline values and, interestingly, use of aflibercept at 3 months (P = 0.013).

Conclusion: Quantifiable metrics of PED morphology improve with treatment, and PED content becomes hyperreflective, more so on aflibercept. Pigment epithelial detachments respond better in the context of more active disease. More hyporeflective PED content may predispose to better treatment response, especially with aflibercept.

In this consecutive case series, reduction in pigment epithelial detachment height and volume and increase in pigment epithelial detachment reflectivity were more pronounced on treatment with aflibercept and were influenced by severity of disease at baseline. Aflibercept treatment achieves greater and faster improvement in quantifiable pigment epithelial detachment metrics at 3 months and 1 year from treatment onset.

*Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom;

Centre for Vision and Hearing Research, University of Manchester, Manchester, United Kingdom;

NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom;

§West Hertfordshire NHS Trust, London, United Kingdom; and

Institute of Ophthalmology, University College London, London, United Kingdom.

Reprint requests: Konstantinos Balaskas, MD, Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom; e-mail:

Supported by a grant from Bayer plc, only in terms of funding investigator's time spent on data collection.

None of the authors has any conflicting interests to disclose.

There was no involvement of the funder in study concept, data analysis and interpretation, writing of the report, or decision to submit the article for publication.

© 2017 by Ophthalmic Communications Society, Inc.