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Brief Report
September 12, 2019

Association Between Cilioretinal Arteries and Advanced Age-Related Macular Degeneration: Secondary Analysis of the Comparison of Age-Related Macular Degeneration Treatment Trials (CATT)

J. Clay Bavinger, MD1; Gui-shuang Ying, PhD1; Ebenezer Daniel, MBBS, PhD1; et al Juan E. Grunwald, MD1; Maureen G. Maguire, PhD1; for the Comparison of Age-Related Macular Degeneration Treatments Trials Research Group
Author Affiliations
  • 1Department of Ophthalmology, University of Pennsylvania, Philadelphia
JAMA Ophthalmol. 2019;137(11):1306-1311. doi:10.1001/jamaophthalmol.2019.3509
Key Points

Question  Is the presence of cilioretinal arteries, supplemental retinal arteries, associated with the incidence of advanced age-related macular degeneration?

Findings  In this cohort study, among 350 patients who did not have advanced age-related macular degeneration in the nonstudy eye at baseline and were followed up for 5 years, no association between the presence of cilioretinal arteries and choroidal neovascularization or geographic atrophy was found.

Meaning  The pathophysiological features of age-related macular degeneration may be secondary to tissue hypoxia and impaired heat dissipation, although no association between cilioretinal arteries and the incidence of advanced age-related macular degeneration was found.

Abstract

Importance  Recent reports suggest that cilioretinal arteries (CRAs) confer protection against developing advanced age-related macular degeneration (AMD).

Objective  To further characterize the association between the presence of a CRA and incidence of geographic atrophy (GA) or choroidal neovascularization (CNV).

Design  This cohort study constituted an ad hoc secondary analysis of data from the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) and was performed at 44 clinical centers in the United States among participants in CATT with CNV in the study eye and without advanced AMD in the fellow eye at baseline. The presence of a CRA was determined by 2 graders, masked to clinical data, using color fundus photographs, red-free fundus photographs, and fluorescein angiography. The proportion with CRAs at baseline between the study eye with CNV and fellow eye without CNV was first compared. The association of a CRA with incidence of CNV or GA at 5 years among fellow eyes and with incidence of GA among study (treated) eyes was then assessed. In addition, the association of CRAs with the Age-Related Eye Disease Study severity scale among the fellow eyes at baseline was assessed. Data were collected from February 1, 2008, through April 30, 2015, and analyzed from July 1, 2018, through April 30, 2019.

Exposures  Presence of a CRA.

Main Outcomes and Measures  The association between the presence of a CRA and incidence of CNV or GA at 5 years of follow-up.

Results  A total of 350 patients (700 eyes) (230 [65.7% women; mean [SD] age, 77 [7.2] years) were included in the analysis. Cilioretinal arteries were present in 67 of 345 (19.4%) fellow eyes without baseline CNV and 73 of 349 (20.9%) study eyes with baseline CNV (P = .60). Cilioretinal arteries in fellow eyes were not associated with incidence of CNV at 5 years (125 of 278 [45.0%] among eyes without CRAs and 30 of 67 [44.8%] among eyes with CRAs; P = .99) or with incidence of GA at 5 years (110 of 278 [39.6%] among eyes without CRAs and 25 of 67 [37.3%] among eyes with CRAs; P = .89). Cilioretinal arteries in study eyes were not associated with incidence of GA at 5 years (105 of 276 [38.0%] study eyes without CRAs and 26 of 73 [35.6%] study eyes with CRAs; P = .72).

Conclusions and Relevance  The analysis did not find a protective association between CRAs and incidence of CNV or GA among CATT participants who had unilateral exudative AMD. Why these findings were different from those of previous publications is unclear but may be partially explained by the different techniques used to detect CRAs or by the baseline advanced disease in CATT participants.

Trial Registration  ClinicalTrials.gov identifier: NCT00593450

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