MACUSTAR clinical study was conceived as a cross-sectional and a longitudinal part. MACUSTAR was set up in seven European countries (Denmark, France, Germany, Italy, Portugal, Netherlands, United Kingdom).
The cross-sectional part: The main objective is to assess the discriminatory properties of each outcome measure, i.e. their ability to discriminate between the different disease stages. 34 patients with early and 43 with late stage AMD, 56 age-matched controls with normal ocular health and 168 patients with iAMD were included.
The longitudinal part: The main goal is to assess the change in outcome measures in a large cohort of iAMD patients (719 total, including 168 iAMD and 34 early AMD patients from cross-sectional part) over a follow-up period of at least 4 years.
The following study activities have been performed:
• Development of a clinical study protocol, of all test paradigms for functional testing, and related SOPs
• Regulatory authorities’ approvals obtained for all 20 participating clinical sites
• An elaborate Quality management system was developed, including the measurement-specific certification process for all technicians and study staff
• Extensive data quality checks of functional testing and imaging data
• Initiation of the clinical study: development of eCRF, legal documents, SOPs, technician certification, setup of the measurement devices for dark adaptation, microperimetry and OCT examinations, site initiation visits
• The study images of 948 patients were screened and graded, resulting in inclusion of 719 study patients by the end of recruitment
• Performance of 3555 follow up visits (291 V3, 520 V4, 474 V5, 440 V6, 430 V7, 413 V8, 425 V9, 315 V10, and 247 V11)
• A patient retention plan was developed to ensure that the subjects included in the longitudinal part of the study completed the 4 years follow-up
• Database cleaning, database lock and data transfer of the cross-sectional and of the 3-years longitudinal data of the study completed
• Statistical analysis of cross-sectional study data was completed according to the statistical analysis plan (SAP) for the cross-sectional study part
• Statistical analysis of the longitudinal study data is ongoing according the the SAP for the longitudinal study part
• Measures to mitigate COVID-19 effects on the study were successfully implemented
Advice was sought from the European Medicines Agency (EMA), U.S. FDA, and NICE to evaluate MACUSTAR protocols for regulatory acceptance at the project’s conclusion. Feedback was integrated into the clinical study protocol. The EMA issued a Letter of Support in February 2018 and a second letter in 2021, endorsing study continuation. In 2024, MACUSTAR requested the EMA´s advice on MACUSTAR 3-year longitudinal data. The third Letter of Support supported the relevance of structural and functional assessments in intermediate AMD, which could serve as enrichment criteria for future clinical trials. The EMA also endorsed use of the VILL questionnaire in future AMD studies:
https://www.ema.europa.eu/en/documents/other/letter-support-intermediate-age-related-macular-degeneration-amd-biomarker-novel-clinical-endpoint-development_en.pdf(opens in new window)To increase visibility, MACUSTAR conducted extensive communication efforts, including a project website (macustar.eu) social media (
https://x.com/Macustar_EU(opens in new window)) bimonthly newsletters, and press releases. These efforts kept the public, patients, doctors, and study staff informed about the study’s objectives and eligibility criteria. MACUSTAR’s scientific findings have been presented at major ophthalmology conferences and published in high-impact scientific journals.
