LAUSR

Dear Editor, We would like to address several issues with the study by Oliveira et al.1 First, there was a selection bias assigned to the fact that four patient groups using different antiangiogenic agents (ranibizumab [Lucentis; Genentech, Inc., South San Francisco, CA, USA] or aflibercept [Eylea; Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA]) and completely varying treatment dosing regimens (pro re nata, monthly, treat and extend, and bimonthly) were lumped together and globally analyzed. The featuring of the demographic and clinical characteristics of the patients was not made separately for each of the four study groups and the four phenotypes of de novo atrophies occurred at the completion of the follow-up, (for example, the complete [cRORA] and incomplete retinal pigment epithelial and outer retinal atrophies and the complete [cORA] and incomplete outer retinal atrophies) were not correlated with the drug type used and the treatment paradigm chosen. Second, some relevant data (Table 1), that should have been included in the multivariate logistic regression model, are missing from the study. Third, regarding the evaluation of the final results of this study, we believe that this should be guided mainly by the structural data with visual changes as a secondary objective. Despite a mean significant gain of 5.4 letters in visual acuity and a significant decrease of the central retinal thickness to the normal limits, there were relatively high proportions of patients with intraretinal fluid (IRF; 38.8%) and subretinal fluid (SRF; 23.5%)1 certifying the wet maculae and the persistence of the disease activity requiring further treatment with anti-vascular endothelial growth factor (VEGF) therapy.2 Fourth, some pertinent findings have resulted from this study,1 with respect to the final outcomes that deserve to be Macular atrophy development in neovascular age-related macular degeneration