Clinical Studies:

CATT: Five-Year Outcomes

Summarized by Landon Rohowetz, MD (Bascom Palmer Eye Institute)

Citations: Maguire MG, Martin DF, Comparison of Age-related Macular Degeneration Treatments Trials Research Group, et al. Five-year outcomes with anti-vascular endothelial growth factor treatment of neovascular age-related macular degeneration: The comparison of age-related macular degeneration treatment trials. Ophthalmology. 2016; 123(8): 1751-1761.

Key Points

  • The CATT trial was a randomized controlled trial comparing the efficacy of bevacizumab and ranibizumab when administered on a monthly or as-needed basis.
  • Patients were randomly assigned to groups defined by drug and dosing regimen. At 1 year, patients on monthly regimens were randomly reassigned to monthly or as-needed regimens.
  • After 2 years, patients were released from the trial protocol. At 5 years, patients were asked to return for examination.
  • At 5 years, mean visual acuity was 3 letters worse than at baseline and 11 letters worse than at 2 years.
  • 50% of patients had a visual acuity of 20/40 or better and 10% had a visual acuity of 20/20 or better, while 20% had a visual acuity of 20/200 or worse.
  • The proportion of eyes with an abnormally thin retina (<120 μm) and geographic atrophy increased from 2 years to 5 years. Mean lesion size increased by more than 50%.
  • The proportion of eyes with retinal fluid decreased the greatest in the first year of treatment and remained relatively constant afterwards. More than 70% of eyes demonstrated retinal fluid at 5 years.
  • Between years 2 and 5.5 years, patients originally assigned to ranibizumab lost more vision than patients originally assigned to bevacizumab. No other differences in visual acuity or morphologic outcomes were observed between regimen or drug groups.
  • Objective:

    Follow-up cohort study evaluating outcomes in patients enrolled in the Comparison of AMD Treatment Trials who returned 5 years after initiation of treatment with ranibizumab or bevacizumab.


    Multicenter cohort study.


Major inclusion criteria:


Patients were initially assigned to one of four study groups based on drug (bevacizumab or ranibizumab) and dosing regimen (monthly or as-needed) using permuted block randomization. At 1 year, patients in the monthly groups were randomly reassigned to either monthly or as-needed treatment with no change in drug assignment. After 2 years, patients were released from the trial and at 5 years, patients were asked to return for examination. Patients who returned underwent a dilated fundus exam, refraction, visual acuity measurement, spectral-domain OCT, fundus color photography, and fluorescein angiography. Data on post-trial visits and treatments were also collected.

RESULTS (2 years)

Study population

Follow-up time


Visual acuity end-points

Anatomic outcomes

Adverse Events