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EFFECT OF INTRAOCULAR PRESSURE–LOWERING MEDICATIONS ON NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATMENT OUTCOMES IN THE COMPARISON OF AGE-RELATED MACULAR DEGENERATION TREATMENT TRIALS

Rahimy, Ehsan, MD*,†; Ying, Gui-shuang, PhD; Pan, Wei, MS; Hsu, Jason, MD

doi: 10.1097/IAE.0000000000002124
Original Study: PDF Only

Purpose: To evaluate the effect of intraocular pressure-lowering medications on treatment outcomes in the Comparison of AMD Treatments Trials.

Methods: Secondary analysis of Comparison of AMD Treatments Trials data. Medication logs were reviewed for continuous 2-year use of agents that increased aqueous outflow (Group A: topical prostaglandins) or suppressed aqueous production (Group B: topical beta blockers and carbonic anhydrase inhibitors). Eyes were excluded if mixed-mechanism intraocular pressure–lowering agents or medications from more than one group were taken. Anatomical and vision responses to treatment at years 1, 2, and over the entire 2-year period in each group were compared with controls (no intraocular pressure–lowering medications).

Results: Inclusion criteria were met by 28 Group A patients, 19 Group B patients, and 857 controls. After 2 years, the control group had a mean visual acuity improvement of +6.3 letters from baseline, compared with +3.5 letters in Group A (P = 0.38), and +13.8 letters in Group B (P = 0.052). Mean retinal thickness change from baseline was −54.9 μm in controls, −80.6 μm in Group A (P = 0.26), and −96.8 μm in Group B (P = 0.13). Mean total thickness change from baseline was −163 μm in controls, −180 μm in Group A (P = 0.63), and −238 μm in Group B (P = 0.08). In longitudinal analysis with adjustment by their baseline values, anti–vascular endothelial growth factor treatment drug and regimen, Group B had more visual acuity improvement (difference of 2.6 letters, 95% confidence interval: −3.4–8.5 letters), more reduction in the retinal thickness (−17.9 μm, 95% confidence interval: −36.5 to 0.7 μm), and total thickness from baseline (mean difference of −54.7 μm, 95% confidence interval: −103 to 6.2 μm) compared with the control group.

Conclusion: Concurrent aqueous suppressant use during anti–vascular endothelial growth factor therapy for neovascular age-related macular degeneration was associated with a trend toward greater reductions in retinal and total thickness as well as improved visual outcomes over 2 years. A similar effect was not observed to the same extent with agents that increase aqueous outflow. Because of the small sample size and secondary analysis, these findings must be cautiously interpreted and perhaps serve as a basis for future prospective studies.

Concurrent use of aqueous suppressants during anti–vascular endothelial growth factor therapy for neovascular age-related macular degeneration was associated with greater reductions in retinal thickness and improved visual outcomes over 2 years in Comparison of AMD Treatments Trials. These results should be confirmed by future prospective randomized studies.

*Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California;

The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania; and

Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Reprint requests: Jason Hsu, MD, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107; e-mail: jhsu@midatlanticretina.com

Supported by NIH U10 EY0\17823, U10 EY017825, U10 EY017826, U10 EY017828 and R21EY023689.

None of the authors has any financial/conflicting interests to disclose.

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© 2018 by Ophthalmic Communications Society, Inc.