Certain OCT Biomarkers Predicted Better and Worse VA for AMD Patients

Patient outcomes with anti-VEGF therapy for AMD remain suboptimal due to clear gaps in efficacy seen between clinical trials and real-world clinical settings. However, OCT biomarker prognostication may help providers individualize care for patients and balance maximizing VA with minimization of treatment burden. Photo: Carolyn Majcher, OD. Click image to enlarge. Treatment decisions for various ocular conditions have more recently been thought of possibly being influenced and informed via technological advancements. OCT is widespread, noninvasive and offers an array of potential biomarkers for many conditions. With neovascular age-related macular degeneration (AMD), researchers of a recent study wanted to see what baseline OCT biomarkers could predict visual acuity (VA) changes at six, 12 and 24 months after anti-VEGF injection.The investigation included 29 reports (8,863 eyes) and evaluated 80 biomarkers via meta-analysis. It was found that two biomarkers predicted better VA at 12 months with low certainty: presence of an intact external limiting membrane and presence of intact ellipsoid zone. For the same time period and also with low certainty, three biomarkers predicted worse VA, including presence of intraretinal fluid, presence of intraretinal fluid in the foveal center point and presence of subretinal hyperreflective material.There were also some results that revealed statistically significant findings but did not cross the five-letter ETDRS threshold to confer a minimally important difference. With a threshold of zero letters and moderate certainty, reduced vision at 12 months was linked to presence of a pigment epithelial detachment, geographic atrophy and both intraretinal and subretinal fluid. Subretinal fluid presence predicted a positive change in VA at 12 months, and absence of a posterior vitreous detachment predicted a negative VA change at 12 months. Negative VA change at 24 months were also predicted via presence of intraretinal fluid in the central 1mm as well as with retinal pigment epithelial elevation and geographic atrophy.The authors mention in the discussion section of their paper that, currently, management of neovascular AMD can be difficult due to a lack of robust individual-level data, making it challenging to counsel patients about the expected clinical course. With the information that this study adds, clinicians may better individualize patient care with suspected biomarkers to indicate whether they are responding or not.The investigators also point to several clinical implications that can be derived from this. Foremost, that “the results of these analyses highlight biomarkers that can be easily identified in routine practice from patients’ structural OCT imaging to predict patients’ prognosis and assist with guiding patient and clinician expectations.”They add that these key biomarkers may be tested in future trials to guide decisions in monitoring and extension intervals as they work toward personalized patient treatment regimens, citing that “valid and reliable biomarkers may help to minimize the burden associated with monitoring and treating patients.”Click here for the journal source. Nanji K, Grad J, Hatamnejad A, et al. Baseline OCT biomarkers predicting visual outcomes in neovascular age-related macular degeneration: a meta-analysis. Ophthalmology. June 24, 2025. [Epub ahead of print].