Subretinal fluid protective in macular atrophy in neovascular age-related macular degeneration

A recent study in Acta Opthamologica by Jorge Sanchez-Monroy and team reports that subretinal fluid appears to protect against Macular Atrophy (MA). Distinguishing the compartment of retinal fluid and understanding its relationship with MA and subretinal fibrosis (SF), can guide the management of neovascular age-related macular degeneration (nAMD).

Retinal fluid is known as a biomarker of activity in neovascular age-related macular degeneration (nAMD) and, because of its association with vision loss, is one of the physician's main guides when treating patients. Recent growing interest in establishing a relationship between the role of retinal fluid and the development of macular atrophy (MA) and subretinal fibrosis (SF), which are strongly associated with poor long-term visual outcomes in eyes treated with nAMD.

The current study aimed to assess the association of macular atrophy (MA) according to the activity of macular neovascularization (MNV) (inactive, only subretinal fluid [SRFL], or active, i.e. including intraretinal fluid [IRFL]) using optical coherence tomography (OCT) in patients with neovascular age-related macular degeneration (nAMD).

A multicentric observational study was designed for treatment-naïve nAMD eyes without subfoveal MA or SF at baseline were included. Eyes were grouped based on their predominant activity status as: (1) mostly inactive, (2) mostly active non-SRFL only [IRFL] or (3) mostly active-SRFL only [onlySRFL]. Kaplan–Meier survival curves estimated the time to development of MA or SF. Cox proportional hazards models evaluated predictors of developing subfoveal MA or SF. The main outcome measure was the risk of developing MA according to predominant MNV activity.

A total of 973 eyes were eligible for analysis. OnlySRFL eyes had lower risk of developing subfoveal MA (HR [95% CI]: 0.56 [0.36, 0.88]; p = 0.024) and extrafoveal MA (HR [95% CI]: 0.41 [0.27, 0.61]; p < 0.001) than IRFL eyes. IRFL eyes had lower visual acuity (VA) (54.5 letters) and the highest proportion of eyes with vision ≤35 letters (25%) at 5 years while onlySRFL eyes had comparable 5-year VA (63.7 letters) to inactive eyes (63.7 letters).

In conclusion subretinal fluid appears to protect against MA. Distinguishing the compartment of retinal fluid and understanding its relationship with MA and SF can guide the management of nAMD.

Reference: Jorge Sánchez-Monroy, Vuong Nguyen, Martin Puzo, Pilar Calvo, Carolina Arruabarrena, Pietro Monaco, Michael Chilov, David Keegan, Daniel Barthelmes, Mark Gillies "Subretinal fluid may protect against macular atrophy in neovascular age-related macular degeneration: 5 years of follow-up from Fight Retinal Blindness registry" ; Acta Opthalmologica, 2022; DOI: https://doi.org/10.1111/aos.15309.