Association Between Ellipsoid Zone Area and Fixation Stability in Macular Telangiectasia Type 2
In brief
In MacTel, each 1 mm2 of ellipsoid-zone loss doubled odds of poor fixation
Among 212 adults with macular telangiectasia type 2, greater ellipsoid-zone area loss was associated with poorer fixation at baseline and 24 months; each additional 1 mm2 doubled the odds of poor fixation. A threshold near 1 mm2 is an exploratory marker, not yet validated, and fixation changes did not significantly differ between implant and sham overall.
- Journal
- Investigative ophthalmology & visual science (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Kensington A Hatcher, Thomas M Aaberg, Joanna Yankey, Eleonora M Lad, Razek G Coussa, Robert Kissling, et al.
- PMID
- 42924992
- DOI
- 10.1167/iovs.67.12.57
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 1 November 2026): MacTel imaging biomarker associated with fixation stability
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.