Baseline OCT Biomarkers Predicting Visual Outcomes in Neovascular Age-Related Macular Degeneration: A Meta-Analysis.
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PURPOSE: To determine the effect estimates and certainty of evidence for baseline optical coherence tomography (OCT) biomarkers predicting visual acuity (VA) and changes in VA from baseline at 6-, 12-, and 24-months following anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration. CLINICAL RELEVANCE: Understanding the prognostic utility of OCT biomarkers can improve treatment decisions. METHODS: Meta-analyses were conducted using random-effects modelling. Results were reported in Early Treatment Diabetic Retinopathy Study (ETDRS) letters. GRADE guidelines for prognostic studies informed certainty of evidence assessments. Results were interpreted using a five-letter minimally important difference (MID). RESULTS: Twenty-nine reports (8,863 eyes) evaluating 80 biomarkers were included. Two biomarkers predicted better VA at 12 months with a 'Low' certainty: the presence of an intact external limiting membrane (ELM) (+14.0; 95%CI:+3.1 to +24.8) and the presence of an intact ellipsoid zone (EZ) (+6.8; 95%CI:+2.8 to +10.8). Three biomarkers predicted worse VA at 12 months with a 'Low' certainty; the presence of intraretinal fluid (IRF) (-5.6; 95%CI:-9.7 to -1.5), the presence of IRF in the foveal center point (-7.4; 95%CI:-10.1 to -4.7), and the presence of subretinal hyperreflective material (SHRM) (-8.7; 95%CI: -19.0 to 1.6).No other biomarker predicted an effect size that crossed the MID. However, there were noteworthy results when interpreting biomarkers with statistically significant findings relative to a threshold of 0 letters and 'Moderate' certainty: the presence of a pigment epithelial detachment, geographic atrophy (GA), and both IRF and subretinal fluid (SRF) predicted reduced vision at 12 months. The presence of SRF predicted a positive change in VA at 12 months. The absence of a posterior vitreous detachment predicted a negative change in VA at 12 months. Lastly, the presence of IRF in the central 1mm, retinal pigment epithelial elevation, and GA predicted negative changes in VA at 24 months. CONCLUSION: With 'Low' certainty evidence, the baseline presence of an intact ELM and EZ predicted better VA at 12 months, and the presence of IRF, IRF in the foveal center point, and SHRM predicted worse VA at 12 months. Improved standardization in biomarker classification and control of confounding variables are needed.
