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Age-related Macular DegenerationNCT03838679

Imaging of the Angiofibrotic Switch in Neovascular AMD

An observational study of Age-related Macular Degeneration and Choroidal Neovascularization, run by Medical University of Vienna at 1 site in Austria.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The content of this research project is to identify the angiofibrotic switch, the transition from angiogenesis to fibrosis, in neovascular age-related macular degeneration (nAMD) longitudinally. Read more about this study

Who is it for?
Ages 50 years and older
What is being tested?
Best-corrected Visual acuity testing (BCVA), Optical coherence tomography (OCT) and Color fundus photography (CFP)
How many people
120 participants
Where
1 siteAustria
Study dates
1 May 2019to 28 Apr 2022
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: There will be two study cohorts in this trial: 1. 80 participants with neovascular AMD and a minimum history of 12 months of anti- VEGF therapy will be included in cohort 1 and examined only once (1 study visit). 2. 40 participants with treatment-naive neovascular AMD receiving standardized anti- VEGF therapy will be included in cohort 2 and followed for 12 months (6 study visits).

Who may be able to join

  • Chronic neovascular AMD with anti-VEGF treatment of a minimum duration of 12 months (cohort 1)
  • Treatment-naïve active neovascular AMD (cohort 2)
  • 50 years of age or older
  • Visual acuity 20/25-20/320
  • At least one druse (>63μm) in either eye or late AMD in the fellow eye
  • Fibrosis <50% of total lesion area at baseline (cohort 2)

Who cannot join

  • Previous treatment for CNV in the study eye (cohort 2)
  • Presence of other progressive retinal disease likely to affect visual acuity
  • Contraindications for treatment with anti-VEGF
  • Pregnancy
  • Dyslexia

Trial locations and contacts

1 site in 1 country.

Austria1 site, 1 recruiting
  • Medical University of Vienna

    Vienna, 1090

    Philipp Roberts, MD PhD, +4314040079400, philipp.roberts@meduniwien.ac.at

    Markus Schranz, MD, +4314040079400, markus.schranz@meduniwien.ac.at

    Recruiting

Other trials in Austria

About this study

Official title: Multimodal Imaging of Subretinal Fibrosis in Neovascular AMD

The content of this research project is to identify the angiofibrotic switch, the transition from angiogenesis to fibrosis, in neovascular age-related macular degeneration (nAMD) longitudinally. Despite optimal treatment about 50% of eyes with nAMD develop fibrosis within 2 years, causing irreversible damage to the retina and functional loss. Objective measurement of fibrosis, however, is challenging, since clinical staging is subjective and current imaging modalities such as color fundus photography (CFP), fluorescein angiography (FA) and optical coherence tomography (OCT) often do not allow clear delineation. Novel imaging modalities such as polarization-sensitive OCT (PS-OCT), OCT angiography (OCTA) and adaptive-optics OCT (AO-OCT) offer identification of fibrous components and microvasculature of fibrotic lesions non-invasively with highest precision and shall thus be used in this study.

Hypotheses: The investigators hypothesize to detect and quantify subclinical (i.e. not detectable on dilated fundus examination) areas of fibrosis using PS-OCT and determine the rate and exact location within the neovascular lesion. Furthermore, the investigators expect neuroretinal and microvascular changes, which will be assessed by AO-OCT and OCTA.

Methods: Eighty eyes of 80 patients with chronic nAMD will be included and examined cross- sectionally to evaluate the accuracy of PS-OCT to detect and quantify fibrosis in comparison to gold standard imaging modalities. In addition, OCTA and AO-OCT will be performed to analyze the relationship between fibrous, neovascular and neuroretinal structures. Furthermore, forty eyes of 40 participants with treatment-naïve nAMD will be included and followed over 12 months with predefined follow-up intervals. Novel non-invasive imaging will be applied to objectively determine the exact time and extent of the angiofibrotic switch in nAMD during state-of-the- art therapy. This approach has not been done before and is clinically relevant for multiple reasons: Firstly, only little is known about the development of fibrosis in AMD during therapy. Secondly, the clinical diagnosis of subretinal fibrosis is subjective and does not allow reliable quantification. Thirdly, current gold standard imaging modalities (i.e. CFP and FA) for detection of fibrosis involve invasive and time-consuming procedures and do not allow three-dimensional analysis. Finally, our study may identify objective endpoints for future interventional trials.

Read the detailed description

Research questions/hypotheses: Age-related macular degeneration (AMD) is the main cause of legal blindness among elderly patients in industrialized countries. The main reason for severe and irreversible visual impairment among these patients is subretinal fibrosis (SF). Large-scale interventional trials (e.g. CATT) have shown that half of all eyes affected by choroidal neovascularization (CNV) develop clinically visible fibrotic scarring over two years despite optimal treatment, causing irreversible retinal damage and functional loss. Thus, prevention of fibrosis in AMD is currently the focus of researchers worldwide. Clearly defined end points for interventional trials, however, are lacking because detection and quantification of SF is challenging. Clinical staging of SF is subjective and current gold standard imaging modalities such as color fundus photography (CFP), fluorescein angiography (FA) and optical coherence tomography (OCT), even in concert, do not allow a distinct and early delineation of SF. Novel imaging modalities such as polarization-sensitive OCT (PS-OCT), OCT angiography (OCTA) and adaptive optics (AO)-OCT are promising means to objectively detect SF and provide detailed insights into the biology of the microvascular and neurosensory compartments. Our group recently demonstrated that PS-OCT offers automated identification and quantification of SF in AMD based on tissue-specific contrast. Aim of the proposed research project is to detect and characterize the angiofibrotic switch, i.e. the transition from active and reversible neovascularization to irreversible fibrosis, in neovascular AMD under anti-VEGF treatment. We hypothesize to detect the initiating events of fibrotic conversion including even subclinical stages of fibrosis by non-invasive PS-OCT and identify the association with fibrovascular and retinal changes by OCTA and AO-OCT, respectively.

Scientific/scholarly innovation/originality of the project: The combination of PS-OCT, OCTA and AO-OCTA to non-invasively detect pathognomonic features of fibrovascular conversion is a novel and unprecedented approach towards objective visualization and quantification of disease pathomechanisms. Outcomes of this study may provide clearly defined morphological endpoints for future interventional trials.

Methods: Eighty eyes of 80 patients with chronic nAMD will be included and examined cross-sectionally to evaluate the accuracy of PS-OCT to detect and quantify fibrosis in comparison to gold standard imaging. In addition, OCTA and AO-OCT will be performed to analyze the relationship between fibrous, vascular and retinal structures. Furthermore, forty eyes of 40 participants with treatment-naïve nAMD will be included in a prospective study and followed for one year under treatment. PS-OCT, AO-OCT and OCTA imaging will be performed according to a standardized protocol at predefined visits. Gold standard imaging will be performed for validation.

Being tested
Best-corrected Visual acuity testing (BCVA), Optical coherence tomography (OCT), Color fundus photography (CFP), Optical coherence tomography angiography (OCTA), Polarization-sensitive optical coherence tomography (PS-OCT)
Medical subject headings
Macular Degeneration, Choroidal Neovascularization

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Best-corrected Visual acuity testing (BCVA)Diagnostic test

    Best-corrected visual acuity (BCVA) will be measured using Early Treatment of Diabetic Retinopathy Study (ETDRS) charts at 4 meters and 1 meter, respectively.

  • Optical coherence tomography (OCT)Diagnostic test

    Optical Coherence Tomography (OCT) is a non-invasive diagnostic technique that renders an in vivo cross sectional view of the retina.

  • Color fundus photography (CFP)Diagnostic test

    Color fundus photography is a non-invasive, fast and reliable imaging method providing a true-to-life depiction of the ocular fundus.

  • Optical coherence tomography angiography (OCTA)Diagnostic test

    OCTA, an extension of conventional OCT, offers noninvasive imaging of the retinal and choroidal vasculature.

  • Polarization-sensitive optical coherence tomography (PS-OCT)Diagnostic test

    PS-OCT, a functional exten- sion of conventional OCT technology, enables differentiation of retinal layers based on their distinct interference with the polarization state of the probing light beam, as opposed to mere light intensity.

  • Microperimetry (MP)Diagnostic test

    Microperimetry allows testing of retinal sensitivity at specific locations in the area of the fovea, parafovea or even more peipheral areas of the macula.

  • Adaptive-optics optical coherence tomography (AO-OCT)Diagnostic test

    AO-OCT, an extension of conventional OCT, offers non-invasive imaging of the retina with improved lateral resolution of up to 2-3 μm.

  • Fluorescein angiography (FA)Diagnostic test

    FA imaging is a standard imaging technique used for the diagnosis of vascular pathologies of the retina such as choroidal neovascularization.

Study groups in NCT03838679
Study groupRoleWhat they receive
Cohort 180 participants with neovascular AMD and a minimum history of 12 months of anti- VEGF therapy will be included in cohort 1 and examined only once (1 study visit).
Receives: Diagnostic Test: Best-corrected Visual acuity testing (BCVA); Diagnostic Test: Optical coherence tomography (OCT); Diagnostic Test: Color fundus photography (CFP); Diagnostic Test: Optical coherence tomography angiography (OCTA); Diagnostic Test: Polarization-sensitive optical coherence tomography (PS-OCT); Diagnostic Test: Microperimetry (MP); Diagnostic Test: Adaptive-optics optical coherence tomography (AO-OCT); Diagnostic Test: Fluorescein angiography (FA)
Cohort 240 participants with treatment-naive neovascular AMD receiving standardized anti- VEGF therapy will be included in cohort 2 and followed for 12 months (6 study visits).
Receives: Diagnostic Test: Best-corrected Visual acuity testing (BCVA); Diagnostic Test: Optical coherence tomography (OCT); Diagnostic Test: Color fundus photography (CFP); Diagnostic Test: Optical coherence tomography angiography (OCTA); Diagnostic Test: Polarization-sensitive optical coherence tomography (PS-OCT); Diagnostic Test: Microperimetry (MP); Diagnostic Test: Adaptive-optics optical coherence tomography (AO-OCT); Diagnostic Test: Fluorescein angiography (FA)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Detection of subretinal fibrosis by PS-OCT

    The primary objective is to determine how well the fibrosis present/not present classification of the novel PS-OCT imaging works compared to gold standard imaging techniques. To assess the primary objective, a 95% confidence interval for the proportion of correct fibrosis yes/no classifications by the novel PS-OCT imaging compared to the gold standard will be computed. To assess this objective, data from cohort 1 will be used.

    Measured: 15 months

Secondary outcomes (1)
  1. Extension of fibrosis area quantified on PS-OCT and correlated to standard imaging modalities

    The secondary objective is to determine how well the fibrosis area detection of the novel PS-OCT imaging works compared to gold standard imaging techniques. To assess the secondary objective, a Bland-Altman plot will be drawn. Furthermore, a 95% confidence interval for the mean difference in detected area and the mean absolute difference in detected area will be computed. To assess this objective, two analysis sets will be used: Firstly, data from cohort 1 and baseline data of cohort 2, and secondly data from the 1 year follow-up examination of patients in cohort 2.

    Measured: 33 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Feb 2019
  2. Study start1 May 2019
  3. Primary completion28 Apr 2022 (estimated)
  4. Study completion28 Apr 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03838679
Sponsor's protocol ID
2019-02-0051
Status last verified
Feb 2020
First submitted
10 Feb 2019
Last updated
20 Feb 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

An observational study of Age-related Macular Degeneration and Choroidal Neovascularization, run by Medical University of Vienna at 1 site in Austria.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 20 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Austria. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Philipp Roberts, MD PhD (+4314040079400, philipp.roberts@meduniwien.ac.at), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Detection of subretinal fibrosis by PS-OCT (time frame: 15 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Feb 2020.

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