Abstract
Clinical trials report substantial gains in visual acuity (VA) for eyes treated with intravitreal anti-VEGF for neovascular AMD (nAMD). In clinical reality, VA outcomes are more variable. Here we investigate pro-re nata treatment frequencies and VA in a real-life cohort of 1382 eyes (1048 patients). Patients with nAMD and one year complete follow-up treated with pro-re nata anti-VEGF between 2009 and 2016 were included. Injection frequency and VA was analyzed clustered by year of first treatment. Baseline parameters were compared between years. Median injection frequency in the first year was 5 with an IQR (interquartile range) of 5 for patients treated in 2009 and 8 with an IQR of 3 for patients treated from 2012 onwards. Median VA outcomes at one year were −5 to ±0 letters for patients treated between 2009 and 2013 and ±0 to +2 letters for patients treated from 2013 onwards. This cohort comprises all severities and subtypes of nAMD. 39% of patients had baseline VA outside the range for the MARINA or ANCHOR clinical trials. Higher treatment frequency was associated with improved VA in our real-life nAMD cohort. With adequate injection frequency, almost 90% of eyes had stable or improved VA over one year. Median VA gains, however, were lower compared to clinical trials. This may be due to a wider range of baseline characteristics in real-life cohorts.
Highlights
Anti vascular endothelial growth factor (VEGF) treatment has revolutionized the treatment of neovascular age-related macular degeneration
This study reports anti-VEGF treatment frequencies and visual acuity from a real-life neovascular AMD cohort (1382 eyes)
The increase in injection frequency over the years was mirrored by a similar increase in visual acuity (VA) outcomes: patients with treatment initiated in 2009 displayed a median VA loss between −4 and −5 letters at the end of year one while patients treated from 2013 onwards showed a median VA outcome between ±0 and +2 letters (Fig. 2B)
Summary
Anti vascular endothelial growth factor (VEGF) treatment has revolutionized the treatment of neovascular age-related macular degeneration (nAMD). Since their introduction into clinical care in 2005, anti-VEGF agents have significantly helped to stabilize and improve vision in hundreds of thousand AMD patients worldwide. Our center has been following a PRN regimen since 2009 that closely resembles the IVAN study regimen[1] (see Methods for details). Using this modified IVAN regimen, we have previously published compound results from five years anti-VEGF treatment[2]. This study describes the differences between a real-life nAMD cohort and clinical trial patients regarding baseline demographics and VA outcomes
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