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2024; Elsevier BV; Volume: 131; Issue: 6 Linguagem: Inglês

10.1016/j.ophtha.2024.02.016

1549-4713

Ingrid U. Scott, Neal L. Oden, Paul VanVeldhuisen, Michael S. Ip, Barbara A. Blodi,

Our goal with the SCORE2 post-treatment data was to demonstrate that the overall usually weak correlation between OCT-measured central subfield thickness and visual acuity letter score belies stronger correlations present in the two segments on either side of an inflection point. The work of other investigators cited in our paper supports this general position, which is physiologically reasonable, in that a retina that is too thin may not support good vision, while a retina that is too thick, with associated fluid, degrades vision. As suggested by Peng et al, a complex and multifactorial relationship may well exist between central subfield thickness and visual acuity letter score, but this need not negate the inflection point relationship we observed in our data. We also see value in a personalized patient-centric predictive approach, with patients having different inflection points based on specific characteristics. Analyses following this idea would involve investigations of patient-level factors in multivariate settings and would presumably involve combinations of univariate indices similar to ours and others. We look forward to future analyses that could elaborate this view. We made no claim of universal applicability in our paper, instead constraining our results to apply only to SCORE2 study participants treated with anti-VEGF therapy for macular edema owing to central retinal vein or hemiretinal vein occlusion. We pointed out that the pattern of inflection points, if they exist, may be different in patients treated for macular edema owing to other etiologies. Missing value issues plague many clinical trials, especially long-term studies like SCORE2. We agree with Peng et al that future studies with more extensive follow-up might expand upon our results. We chose to keep results based on later data (months 36, 48, and 60) in our paper, despite the larger numbers of missing values, because the later results were qualitatively so similar to results from earlier months, which had fewer missing values. We acknowledged the limitations of issues related to missing data in the discussion section of the paper. Once again, we thank Peng et al for their interest in our work. For there to be scientific progress, it is critical that research be carefully peer evaluated to help set the direction for future investigation and analyses. Re: Scott et al.: SCORE2 Report 24: Nonlinear relationship of retinal thickness and visual acuity in central retinal and hemiretinal vein occlusion. (Ophthalmology. 2023;130:1066–1072)OphthalmologyPreviewWe enthusiastically immersed ourselves in the comprehensive study conducted by Scott et al.1 The research meticulously explores the correlation between central subfield thickness (CST) and visual acuity letter score (VALS) in eyes treated with aflibercept or bevacizumab for macular edema associated with central retinal vein occlusion or hemiretinal vein occlusion. The key finding of the study was that a thinner retina is not always associated with better VALS. Full-Text PDF