Effect of retinal thickness variability on visual outcomes and fluid persistence in neovascular age-related macular degeneration: a post hoc analysis of the HAWK and HARRIER studies

To determine the association between central subfield thickness (CST) variability and visual outcomes in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor therapies. In this post hoc, treatment-agnostic analysis, patients (N=1752) were grouped into quartiles of increasing CST variation. The association between CST variability and best-corrected visual acuity (BCVA) was measured from baseline, or from the end of the loading phase, until the end of the study using a multilevel modelling for repeated measures model. The association between CST variability and the presence of retinal fluid was also assessed. Increased CST variability was associated with worse BCVA outcomes at the end of study, with a least square mean difference in BCVA of 8.9 ETDRS letters between the quartiles with the lowest and highest CST variability at the final visit. Increased variability was also associated with a higher mean fraction of visits with the presence of fluid. More stable CST was associated with better visual outcomes at the end of treatment suggesting that CST variability may provide a more reliable prognostic marker of visual outcomes than the presence of fluid alone, with potential to enhance the clinical care of nAMD patients.