Foveal Morphology Affects Self-Perceived Visual Function and Treatment Response in Neovascular Age-Related Macular Degeneration: A Cohort Study

OBJECTIVES To investigate the relationship between foveal morphology and self-perceived visual function in patients with neovascular age-related macular degeneration (AMD) and whether foveal characteristics are associated with Ranibizumab treatment response on the self-perceived visual function. METHODS This prospective cohort study included patients with newly diagnosed neovascular AMD found eligible for treatment with Ranibizumab. Foveal morphology of both eyes was assessed using spectral-domain optical coherence tomography and all patients were interviewed using the 39-item National Eye Institute Visual Function Questionnaire (VFQ). Patients were re-interviewed 3 and 12 months after initiation of treatment with Ranibizumab. We evaluated foveal morphology at baseline in relation to VFQ scores at baseline and clinically meaningful changes in VFQ after 3 and 12 months. RESULTS VFQ scores correlated with central foveal thickness, central foveal thickness of neuroretina (CFN), foveal RPE elevation, foveal integrity of the photoreceptor inner segment/outer segment junction (IS/OS), and external limiting membrane. In a multiple linear regression model, only best-corrected visual acuity of the better eye (p<0.001) and the IS/OS status in the better eye (p = 0.012) remained significant (Adjusted R(2) = 0.418). Lower baseline VFQ and a baseline CFN within 170-270 µm in the better eye were both associated with a clinically meaningful increase in the VFQ scores after 3 and 12 months. An absent foveal IS/OS band in the better eye was associated with a clinically meaningful decrease in the VFQ scores at 12 months. CONCLUSIONS Foveal morphology in the better eye influences the self-perceived visual function in patients with neovascular AMD and possesses a predictive value for change in the self-perceived visual function at 3 and 12 months after initiation of treatment. These findings may help clinicians provide patients more individualized information of their disease and treatment prognosis from a patient-perceived point-of-view.