A Retrospective Analysis of the Effect of Subretinal Hyper-Reflective Material and Other Morphological Features of Neovascular Age-Related Macular Degeneration on Visual Acuity Outcomes in Eyes Treated with Intravitreal Aflibercept over One Year

A retrospective study of 176 treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) that had undergone intravitreal aflibercept treatment (2.0 mg, 7–8 times over one year) was performed to correlate the effect of aflibercept on the morphological features of nAMD—subretinal hyper-reflective material (SHRM), pigment epithelial detachment (PED), subretinal fluid (SRF), and intraretinal fluid (IRF)—with visual acuity at baseline and at one year. Spectral-Domain Optical Coherence Tomography (SD-OCT) images and best-corrected visual acuity (BCVA) at baseline and at one year were obtained. The relationship between visual acuity and the presence of morphological features at baseline and at one year was statistically analysed. The proportion of eyes with PED (p = 0.01), SRF (p ≤ 0.001), and IRF (p ≤ 0.001) reduced at one year. SHRM (p = 0.002) and IRF (p = 0.0001) were associated with poorer baseline BCVA. The presence of SRF at baseline was associated with better baseline BCVA (p = 0.004) and 5.3 letters of improvement of BCVA after one year of treatment (p = 0.0001). For each letter increase in BCVA at baseline, 0.25 fewer letters were gained in BCVA at one year. While aflibercept can improve morphological abnormalities in nAMD, this is not always accompanied by a corresponding improvement in visual acuity