Abstract
ObjectiveTo study the treatment patterns and visual outcome over one year in Asian patients with choroidal neovascular membrane secondary to age-related macular degeneration (AMD-CNV) and polypoidal choroidal vasculopathy (PCV).DesignProspective cohort, non-interventional study.Methods132 treatment-naïve patients who received treatment for AMD-CNV and PCV were included. All patients underwent standardized examination procedures including retinal imaging at baseline and follow-up. AMD-CNV and PCV were defined on fundus fluorescein angiography and indocyanine green angiography at baseline. Patients were treated according to standard of care.We report the visual acuity (VA) and optical coherence tomography (OCT) measurements at baseline, month 3 and month 12 The factors influencing month 12 outcomes were analyzed.Main Outcome MeasureType of treatment, number of Anti-vascular endothelial growth factor (VEGF) treatments, visual outcome over one year.ResultsAnti-VEGF monotherapy was the initial treatment in 89.1% of AMD-CNV, but only 15.1% of PCV. The mean number of anti-VEGF injections up to month 12 was 3.97 (4.51 AMD-CNV, 3.43 PCV, p = 0.021). Baseline OCT, month 3 OCT and month 3 VA were significant in determining continuation of treatment after month 3. At month12, mean VA improved from 0.82 (∼20/132) at baseline to 0.68 (∼20/96) at month 12 (mean gain 6.5 ETDRS letters, p = 0.002). 34.2% of eyes (38/113 eyes) gained ≥15 ETDRS letters and 14.4% (16/113 eyes) lost ≥15 ETDRS letters. There were no significant differences in visual outcome between AMD-CNV and PCV (p = 0.51). Factors predictive of month 12 visual outcome were baseline VA, baseline OCT central macular thickness, month 3 VA and age.ConclusionsThere is significant variation in treatment patterns in Asian eyes with exudative maculopathy. There is significant visual improvement in all treatment groups at one year. These data highlight the need for high quality clinical trial data to provide evidence-based management of Asian AMD.
Highlights
Age-related macular degeneration (AMD) is one of the major causes of blindness worldwide [1,2,3,4]
Anti-vascular endothelial growth factor (VEGF) monotherapy was the initial treatment in 89.1% of AMD-CNV, but only 15.1% of polypoidal choroidal vasculopathy (PCV)
Baseline optical coherence tomography (OCT), month 3 OCT and month 3 visual acuity (VA) were significant in determining continuation of treatment after month 3
Summary
Age-related macular degeneration (AMD) is one of the major causes of blindness worldwide [1,2,3,4]. There are few studies which have examined treatment pattern and outcomes of exudative maculopathy in Asians, it is often assumed that similar results with anti-VEGF therapy can be expected for eyes with choroidal neovascularization secondary to typical AMD (AMD-CNV) while different treatment appears to be required for the polypoidal choroidal vasculopathy (PCV) subtype [19,20]. Lack of government funded reimbursement in many Asian countries, potential differences in patient understanding and expectation, and uncertainties of the role of anti-VEGF mono-therapy in PCV, may all affect the pattern of therapy in an Asian setting [20,21,22,23,24]. Significant heterogeneity remains in the management of Asian eyes with exudative maculopathy, in terms of diagnosis, optimal treatment and outcome
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