Anti-vascular Endothelial Growth Factor (VEGF) Treatment in Neovascular Age-Related Macular Degeneration: Outcomes and Outcome Predictors

Abstract

Anti-vascular endothelial growth factor (VEGF) treatment maintains vision in most and improves vision in a considerable proportion of patients with neovascular age-related macular degeneration (nvAMD). Treatment outcomes in routine medical care seem to be best with a Treat & Extend regimen. However, overall results in routine medical care are lacking behind those achieved in highly standardized clinical phase III trials of monthly anti-VEGF treatment for a number of reasons, such as different patient populations and less intense treatment. Several clinical factors can predict anti-VEGF treatment outcomes. Those who present at a younger age, with better baseline vision and smaller CNV lesions are more likely to have a better final visual outcome, although individuals with better visual acuity at baseline stand to gain fewer letters due to a ceiling effect. Genetic factors, predominantly related to CFH and VEGF-A gene polymorphisms, may also be associated with anti-VEGF treatment outcomes. However, whilst genetic factors have been strongly associated with the development of nvAMD, their overall effect on anti-VEGF treatment outcome appears to be small. Clinical factors at presentation as well as intensity of treatment largely determine current anti-VEGF treatment outcomes. The most important factor is baseline visual acuity. Persons who present with better visual acuity will maintain better visual acuity with anti-VEGF treatment in the long term. This emphasizes the need to identify newly incident nvAMD rapidly and increase public awareness.