Macular Morphology and Visual Acuity
in the Comparison of Age-related
Macular Degeneration Treatments
Trial (CATT)
Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire, MG,
Ying G-S, Grunwald JE, Huang J for the CATT Research Team
Available through
http://www.med.upenn.edu/cpob/publications_main.shtml
Supported by Cooperative Agreements from the
National Eye Institute, National Institutes of Health,
DHHS
1
Presence and Type of Fluid on OCT Over Time
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
2
Impact Over Time of Drug & Dosing Regimen on
OCT–Determined Thickness Measurements
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
3
Retinal thickness category over
time by treatment group
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
4
Lesion Components Under the Foveal
Center by Drug and Dosing Regimen
Week
Foveal Intraretinal
Fluid Present
Yes
0
No
Yes
4
No
Yes
12
No
Yes
24
No
Yes
52
No
Retinal Thickness Category (µ)
Ranibizumab Monthly
Bevacizumab Monthly
Ranibizumab PRN
Bevacizumab
PRN
<120
120 to 212
>212
<120
120 to 212
>212
3(2.0%)
56(38.1%)
88(59.9%)
28(19.2%)
105(71.9%)
13(8.9%)
3(2.1%)
47(33.1%)
92(64.8%)
22(16.4%)
95(70.9%)
17(12.7%)
7(5.3%)
35(26.7%)
89(67.9%)
24(15.3%)
110(70.1%)
23(14.6%)
5(3.4%)
50(33.6%)
94(63.1%)
25(17.5%)
100(69.9%)
18(12.6%)
<120
120 to 212
>212
<120
120 to 212
>212
5(7.4%)
47(69.1%)
16(23.5%)
55(25.7%)
148(69.2%)
11(5.1%)
3(4.1%)
43(58.9%)
27(37.0%)
45(22.6%)
139(69.8%)
15(7.5%)
4(6.1%)
48(72.7%)
14(21.2%)
51(23.4%)
153(70.2%)
14(6.4%)
5(6.6%)
48(63.2%)
23(30.3%)
41(20.4%)
139(69.2%)
21(10.4%)
<120
120 to 212
>212
<120
120 to 212
>212
6(10.2%)
41(69.5%)
12(20.3%)
50(24.4%)
148(72.2%)
7(3.4%)
6(10.0%)
35(58.3%)
19(31.7%)
34(17.8%)
148(77.5%)
9(4.7%)
5(7.7%)
33(50.8%)
27(41.5%)
44(21.5%)
154(75.1%)
7(3.4%)
8(8.2%)
57(58.2%)
33(33.7%)
32(18.7%)
127(74.3%)
12(7.0%)
<120
120 to 212
>212
<120
120 to 212
>212
3(6.5%)
30(65.2%)
13(28.3%)
46(21.7%)
159(75.0%)
7(3.3%)
6(9.5%)
34(54.0%)
23(36.5%)
36(20.0%)
134(74.4%)
10(5.6%)
3(5.3%)
34(59.6%)
20(35.1%)
53(25.6%)
142(68.6%)
12(5.8%)
8(10.1%)
43(54.4%)
28(35.4%)
36(20.8%)
128(74.0%)
9(5.2%)
<120
120 to 212
>212
<120
120 to 212
>212
2(7.7%)
17(65.4%)
7(26.9%)
69(28.4%)
163(67.1%)
11(4.5%)
6(11.8%)
23(45.1%)
22(43.1%)
42(20.8%)
146(72.3%)
14(6.9%)
4(8.7%)
27(58.7%)
15(32.6%)
49(22.0%)
161(72.2%)
13(5.8%)
4(7.0%)
33(57.9%)
20(35.1%)
49(24.0%)
139(68.1%)
16(7.8%)
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
5
Foveal Lesion Composition
Baseline
Week 52
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
6
Involvement of the foveal center by CNV
or sequelae of CNV at week 52
(A)Ranibizumab Monthly
Non-geographic
Atrophy
18.5%
(B) Bevacizumab Monthly
Geographic
Atrophy
2.6%
Geographic
Atrophy 0.8%
Fluid Only
10.9%
Blocked
Fluorescence
5.3%
CNV
21.5%
Can't Grade
3.0%
Other
2.3%
Blocked
Fluorescence
4.9%
CNV 21.2%
SPED 0.4%
No Pathology
24.9%
Scar 20.4%
RPE Tears 0.8%
Scar
RPE Tears 16.2%
1.5%
Other 4.9%
(C) Ranibizumab PRN
Non-geographic
Atrophy 14.5%
Fluid Only 8.2%
Can't Grade
1.6%
SPED
0.4%
No Pathology
17.7%
Non-geographic
Atrophy 11.8%
(D) Bevacizumab PRN
Geographic
Atrophy 1.1%
Fluid Only 4.5%
Blocked
Fluorescence
3.4%
CNV 26.5%
Non-geographic
Atrophy 13.3%
Geographic
Atrophy 3.1%
Fluid Only 9.4%
CNV 29.8%
Blocked
Fluorescence
1.6%
Can't Grade
2.4%
Can't Grade 3.4%
No Pathology
20.1%
SPED 1.1%
No Pathology
16.1%
SPED 0.4%
Other 3.9%
Other 4.8%
RPE Tear 0.7%
Scar 18.8%
Scar 19.0%
Hemorrhage
0.7%
RPE Tears 0.8%
Hemorrhage
0.4%
7
Mean visual acuity by status of fluid
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
8
Retinal thickness and Visual Acuity
at Baseline and Follow-up
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
9
Nonlinear relationship of visual acuity with
foveal total thickness during follow-up
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
10
Mean VA by Neovascular Lesion Area and
Pathology in Foveal Center at Week 52 (N=1053)
Fundus Feature at Week 52
Neovascular lesion area (mm2)
≥0 to ≤1.92
>1.92 to ≤4.96
>4.96 to ≤9.62
>9.62
Missing
Pathology in foveal center
None
Fluid only
Choroidal neovascularization or
serous pigment epithelium
detachment
Non-geographic atrophy
Geographic atrophy,
hemorrhage, RPE§ tear,
blocked fluorescence
N
Unadjusted Mean
Visual Acuity Score
(Standard Error)
P values*
<0.0001
244
246
74.3 (1.11)
70.4 (1.10)
245
242
76
67.1 (1.10)
61.9 (1.11)
63.1 (1.98)
<0.0001
202
85
259
73.9 (1.20)
75.3 (1.85)
69.7 (1.06)
151
66.5 (1.39)
72
64.8 (2.01)
Scar
188
59.5 (1.25)
Other§ or missing
96
66.8 (1.75)
*1-way analysis of variance
RPE = retinal pigment epithelium
§Other includes pigment, drusenoid pigment epithelial detachment and non-leaking choroidal neovascularization
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
11
Adjusted Mean Visual Acuity for OCT and
Fundus Features at Week 52 (n=1004)∗
*Subjects (n=49) with missing data for fluid or retinal thickness were excluded.
CNV= choroidal neovascularization
RPE = retinal pigment epithelium
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
12
Conclusions

Anti–vascular endothelial growth factor (VEGF) therapy reduced
lesion activity and improved VA in all treatment groups.

At all time points, eyes with residual IRF had worse VA than those
without.

Eyes with abnormally thin or thick retinas, residual large lesions,
and scar also had worse VA.

Monthly ranibizumab dosing yielded more eyes with no fluid and
an abnormally thin retina, although the long-term significance is
unknown.

These results have important treatment implications in eyes
undergoing anti-VEGF therapy for neovascular
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03