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Peer-reviewedCC BY 4.0Investigative Ophthalmology & Visual Science

Association Between Ellipsoid Zone Area and Fixation Stability in Macular Telangiectasia Type 2

  • Kensington A. Hatcher1
  • Thomas M. Aaberg1,2
  • Joanna Yankey3
  • Eleonora M. Lad4
  • Razek G. Coussa5
  • Robert Kissling1
  • Muna I. Bitar1
5 affiliations
  1. 1Neurotech Pharmaceuticals, Cumberland, Rhode Island, United States
  2. 2Foundation for Vision Research, Grand Rapids, Michigan, United States
  3. 3Veristat, Southborough, Massachusetts, United States
  4. 4Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
  5. 5Retina Vitreous Consultants of Wisconsin, Milwaukee, Wisconsin, United States
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Abstract

Purpose: To determine whether ellipsoid zone (EZ) area loss, a biomarker of photoreceptor degeneration, is associated with fixation stability in macular telangiectasia type 2 (MacTel).

Methods: This retrospective analysis included 212 adults from two Phase 3 trials of revakinagene taroretcel-lwey for MacTel. EZ area loss was quantified with optical coherence tomography. Fixation stability (P1 index) was measured by microperimetry. Linear and logistic regressions evaluated associations between EZ area loss and P1 over 24 months. A median split stratified the population to evaluate whether baseline EZ area loss influenced the therapeutic effect of the implant versus sham. A receiver operating characteristic analysis identified a structural threshold for unstable fixation.

Results: EZ area loss was significantly associated with reduced fixation stability at baseline (P = 0.002) and month 24 (P = 0.01). Each 1-mm² increase in EZ area loss doubled the odds of poor fixation stability (defined as a P1 <80%) (odds ratio, 2.07; P = 0.047). P1 change did not significantly differ between the treatment and sham groups. In exploratory analyses, stratification by median baseline EZ area loss, despite a nonsignificant treatment-by-baseline interaction (P = 0.17), revealed a greater decline in fixation stability in sham-treated eyes (mean, −3.8%) versus the implant group (+0.6%). The receiver operating characteristic analysis identified an EZ area loss threshold of 1.075 mm² for unstable fixation.

Conclusions: Greater EZ area loss is associated with poorer fixation stability in MacTel. An EZ area loss threshold of ∼1 mm² may serve as an exploratory marker of fixation instability risk, though this threshold requires independent validation.

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Cite

BibTeXRIS
BibTeX
@article{hatcher2026association,
  title = {{Association Between Ellipsoid Zone Area and Fixation Stability in Macular Telangiectasia Type 2}},
  author = {Kensington A. Hatcher and Thomas M. Aaberg and Joanna Yankey and Eleonora M. Lad and Razek G. Coussa and Robert Kissling and Muna I. Bitar},
  journal = {Investigative Ophthalmology \& Visual Science},
  year = {2026},
  month = oct,
  doi = {10.1167/iovs.67.12.57},
  url = {https://doi.org/10.1167/iovs.67.12.57},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Association Between Ellipsoid Zone Area and Fixation Stability in Macular Telangiectasia Type 2
AU  - Kensington A. Hatcher
AU  - Thomas M. Aaberg
AU  - Joanna Yankey
AU  - Eleonora M. Lad
AU  - Razek G. Coussa
AU  - Robert Kissling
AU  - Muna I. Bitar
PY  - 2026
DA  - 2026/10/23
JO  - Investigative Ophthalmology & Visual Science
DO  - 10.1167/iovs.67.12.57
UR  - https://doi.org/10.1167/iovs.67.12.57
AB  - Purpose: To determine whether ellipsoid zone (EZ) area loss, a biomarker of photoreceptor degeneration, is associated with fixation stability in macular telangiectasia type 2 (MacTel).  Methods: This retrospective analysis included 212 adults from two Phase 3 trials of revakinagene taroretcel-lwey for MacTel. EZ area loss was quantified with optical coherence tomography. Fixation stability (P1 index) was measured by microperimetry. Linear and logistic regressions evaluated associations between EZ area loss and P1 over 24 months. A median split stratified the population to evaluate whether baseline EZ area loss influenced the therapeutic effect of the implant versus sham. A receiver operating characteristic analysis identified a structural threshold for unstable fixation.  Results: EZ area loss was significantly associated with reduced fixation stability at baseline (P = 0.002) and month 24 (P = 0.01). Each 1-mm² increase in EZ area loss doubled the odds of poor fixation stability (defined as a P1 <80%) (odds ratio, 2.07; P = 0.047). P1 change did not significantly differ between the treatment and sham groups. In exploratory analyses, stratification by median baseline EZ area loss, despite a nonsignificant treatment-by-baseline interaction (P = 0.17), revealed a greater decline in fixation stability in sham-treated eyes (mean, −3.8%) versus the implant group (+0.6%). The receiver operating characteristic analysis identified an EZ area loss threshold of 1.075 mm² for unstable fixation.  Conclusions: Greater EZ area loss is associated with poorer fixation stability in MacTel. An EZ area loss threshold of ∼1 mm² may serve as an exploratory marker of fixation instability risk, though this threshold requires independent validation.
SN  - 0146-0404
SN  - 1552-5783
ER  -