Decisional answer tree analysis of exudative age-related macular degeneration treatment outcomes
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ORIGINAL PAPER
Decisional answer tree analysis of exudative age-related macular degeneration treatment outcomes Shi Zhuan Tan • Augustinus Laude • Peter A. Aspinall • Anna M. Ambrecht Archana Vani • Baljean Dhillon
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Received: 11 April 2012 / Accepted: 8 January 2013 Ó Springer Science+Business Media Dordrecht 2013
Abstract The use of intravitreal ranibizumab in exudative age-related macular degeneration (eAMD) has become commonplace. We aim to investigate the early predictors of this treatment outcome. Seventyone treatment-naive eyes of 71 patients with eAMD of all lesion subtypes who received intravitreal ranibizumab treatment and completed 12 months of follow-up were included. All patients were loaded with three injections of ranibizumab at monthly intervals. Further injections were given if clinically indicated based on logMAR best-corrected visual acuity (BCVA) and optical coherence tomography findings. Casenotes of eligible patients were reviewed retrospectively. The main outcome measure was logMAR BCVA change at month 12. The mean number of
injections given over 12 months was 5.4 ± 1.9. A total of 88.7 % of the patients achieved visual stabilisation (loss of \15 letters) and 15.0 % achieved visual improvement (gain of C15 letters). The mean letter change at 12 months was ?0.3 letters. Regression analysis showed that baseline BCVA and letter change at month 3 predicted visual acuity outcome at month 12 (baseline BCVA: t = 6.97, p \ 0.001; letter change: t = 5.84, p \ 0.01) but age, gender and eAMD in the fellow eye were not predictive. Finally, a decisional answer tree model demonstrated that letter change at month 3 was a strong predictor of visual outcome at month 12 with an overall accuracy of 69 %. We found that letter change from baseline at month 3 was strongly predictive of visual outcome at month 12.
S. Z. Tan Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK
Keywords Exudative age-related macular degeneration Ranibizumab Decisional answer tree analysis Treatment outcome
S. Z. Tan A. Laude A. M. Ambrecht A. Vani B. Dhillon Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh EH3 9HA, UK
Introduction A. Laude (&) National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore e-mail: [email protected] P. A. Aspinall Visual Impairment Research Group, School of the Built Environment, Heriot-Watt University, Edinburgh, UK
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among people aged C50 years in the developed world [1]. The wet form of AMD is a complex disease that likely involves multiple angiogenic agents, especially vascular endothelial growth factor (VEGF) that contribute to the
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Int Ophthalmol
development of choroidal neovascularisation (CNV) [2]. Many anti-VEGF drugs have since been tested to target this angiogenic agent. The most successfully tested anti-VEGF drug to date is intravitreal ranibizumab (Lucentis; Genentech, Inc., San Franc
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