26. Effect on High Contrast Discriminated Target Central
Fields of Avastin Monotherapy for CNVM due to AMD
Stephen H. Sinclair (Media)
Purpose: Vision outcomes for treatment of AMD CNVM have been previously evaluated using
visual acuity with severe limitations. Central visual field testing with discriminated targets
appears to offer significant advantages. This pilot study evaluated the short-term effect of
Avastin on CNVM due to AMD.
Methods: In this cohort, 16 eyes of 15 patients underwent 3 courses of Avastin monotherapy
at 6-week intervals and were evaluated prior to and 1 month following the last treatment with
IVFA, OCT, best corrected VA by ETDRS, and testing of central 10o radius visual fields with high
contrast discriminated targets (MAVES interactive computer program). Angiograms were
assessed for CNVM type and were graded for amount of subretinal fluid, exudates, hemorrhage,
severity of leakage, and RPE atrophy. OCT was evaluated for retinal thickness, presence of subretinal fluid, and presence of
PED. Correlations were drawn between these and visual field alterations.
Results: Among the 16 eyes, 13 had prior treatment with PDT and intravitreal triamcinolone. Seven eyes demonstrated complete
involution with minimal or no residual leakage after 3 courses of Avastin but with variable fibrosis and RPE atrophy.
In 9 eyes there was minimal or no response. Overall, best-corrected visual acuity improved by 4.5 letters (0.08 logMAR), but
among the 7 eyes with complete or partial regression, VA improved by 0.10 logMAR (6.33 letters) compared with 0.06
logMAR (2.14 letters) in those with a poor response. The MAVE central acuity (best acuity within 4 degrees radius of fixation)
among all the eyes did not improve (0.02 logMAR) but in those that responded to treatment, it improved 0.1 logMAR
compared to losing 0.09 logMAR in those which did not respond. The MAVE global acuity (weighted average of thresholded
acuities across all intercepts) declined 0.11 logMAR overall while the 7 eyes that responded, demonstrated no change and
those that did not respond lost 3 lines (0.31 logMAR). OCT retinal thickness improved in all eyes by 25 microns, with no
difference among those responding versus those that did not. Among the 7 eyes with complete or partial CNVM involution,
discriminated target central fields demonstrated shrinkage of central scotoma size in 5, but enlargement in 2. Improvement
in central scotoma density was noted in 5. Resultant scotoma size or density was inversely associated with severity and area
of RPE atrophy, residual exudates or hemorrhage, and the severity and area of fibrosis.
Conclusions: In this small pilot study of Avastin treatment of CNVM due to AMD, central visual field testing with discriminated
targets appear to offer improved understanding of retinal pathology and resulting vision.