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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)

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

10.1016/j.ophtha.2024.02.015

1549-4713

Peng Wu, Rongyu Gao, Guangsen Liu,

Retinal Diseases and Treatments

We enthusiastically immersed ourselves in the comprehensive study conducted by Scott et al.1Scott I.U. Oden N.L. VanVeldhuisen P.C. et al.SCORE2 Report 24: nonlinear relationship of retinal thickness and visual acuity in central retinal and hemiretinal vein occlusion.Ophthalmology. 2023; 130: 1066-1072Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar 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. Although the study presents valuable insights, we would like to raise a few points of concern. First, the study largely relies on the 2-segment linear regression model, which, despite its robustness in this context, may oversimplify the complex, multifactorial relationship between CST and VALS. Multiple regression models accounting for other potential confounding variables such as age, comorbidities, and treatment duration may provide a more comprehensive understanding of the association. Second, the study's conclusions are based on the assumption that the inflection points of 217 to 256 mm, beyond which increasing CST is associated with decreasing VALS, are universally applicable. However, this finding may not hold true for every patient owing to individual variability in retinal and visual structures. A patient-centric approach considering individual anatomical and physiological differences may yield more accurate predictions of visual outcomes. Human visual function and retinal structure exhibit significant interindividual variability, influenced by factors such as age, genetic background, and the presence of systemic or ocular diseases.2Boomi Quchan Atigh S. Sadat Shakeri H. Esmaily H. et al.Evaluation of visual functions in Iranian hypothyroid adults.Endocrinol Diabetes Metab. 2023; 6: e393https://doi.org/10.1002/edm2.393Crossref PubMed Scopus (0) Google Scholar,3Wang S. Xu L. Jonas J.B. et al.Dyslipidemia and eye diseases in the adult Chinese population: the Beijing eye study.PLoS One. 2012; 7e26871https://doi.org/10.1371/journal.pone.0026871Crossref Scopus (44) Google Scholar These individual differences could potentially affect the relationship between CST and VALS, leading to different inflection points for different individuals. Therefore, a patient-centric approach that considers these individual anatomical and physiological differences may be more suitable for predicting visual outcomes. Such an approach would allow for personalized predictions and treatment plans, potentially improving patient outcomes and satisfaction. Furthermore, the study's long-term follow-up was significantly impacted by attrition, with only 51% of the patients completing a visit at month 60. This high dropout rate could have introduced bias, as the patients who remained in the study might differ systematically from those who dropped out, potentially influencing the study results.4Kristman V. Manno M. Côté P. Loss to follow-up in cohort studies: how much is too much?.Eur J Epidemiol. 2004; 19: 751-760Crossref PubMed Scopus (535) Google Scholar This attrition rate not only decreases the statistical power of the study, but also limits the generalizability of the findings. Patients who completed the follow-up may not be representative of the initial cohort or the broader patient population, limiting the applicability of the findings to other groups.5Besal R. Adamič P. Beović B. et al.Systemic antimicrobial treatment of chronic steomyelitis in adults: a narrative review.Antibiotics (Basel). 2023; 12: 944https://doi.org/10.3390/antibiotics12060944Crossref PubMed Scopus (3) Google Scholar Therefore, future studies should aim for a more extensive follow-up and larger sample size to provide more reliable and generalizable evidence. In conclusion, although the authors' investigation into the nonlinear association between CST and VALS is commendable, we believe a more nuanced approach considering individual patient characteristics and a larger sample size for long-term follow-up would strengthen the findings. We look forward to further research in this intriguing area of ophthalmology. SCORE2 Report 24: Nonlinear Relationship of Retinal Thickness and Visual Acuity in Central Retinal and Hemiretinal Vein OcclusionOphthalmologyVol. 130Issue 10PreviewTo investigate whether a nonlinear association between central subfield thickness (CST) on spectral-domain OCT and concurrent visual acuity letter score (VALS) exists in eyes treated initially with aflibercept or bevacizumab for macular edema associated with central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2). Full-Text PDF ReplyOphthalmologyPreviewOur 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. Full-Text PDF