Abstract
Background/objectivesTo investigate the association between optical coherence tomography (OCT) markers of lesion activity and changes in visual acuity (VA) during anti-vascular endothelial growth factor (anti-VEGF) therapy of eyes diagnosed with neovascular age-related macular degeneration (nAMD); and how VA and OCT markers are considered in physicians’ decision to retreat with anti-VEGFs.Subjects/methodsRetrospective, non-comparative, non-randomised cohort study involving electronic medical record data collected from 1190 patient eyes with nAMD diagnosis at two sites in the United Kingdom. Two sub-cohorts consisting of 321 and 301 eyes, respectively, were selected for analyses.ResultsIn 321 eyes, absence of IRF or SRF at ≥2 clinic visits resulted in a gain of five ETDRS letters from baseline, compared with two letters gained in eyes with <2 clinic visits with absence of IRF (p = 0.006) or SRF (p = 0.042). Anti-VEGF treatment was administered at 421 clinic visits, and 308 visits were without treatment. Comparing treatment visits with non-treatment visits, the maximum difference in frequency of OCT markers of lesion activity were for intraretinal fluid (IRF; 24% versus 5%) and subretinal fluid (SRF; 32% versus 5%). Pigment epithelial detachment (PED) was reported in 58% of treatment visits compared with 36% in non-treatment visits. VA loss was not a consistent trigger for retreatment as it was present in 63% of injection visits and in 49% of non-injection visits.ConclusionsRetreatment decision making is most strongly influenced by the presence of IRF and SRF and less by the presence of PED or VA loss.
Highlights
Neovascular age-related macular degeneration is a late-stage manifestation of a chronic degenerative disease affecting the macular retina [1, 2]
The first anti-vascular endothelial growth factor (VEGF) injection was given between 1st September 2010 and 4th October 2017 and patients were followed for a minimum of 12 months
The sub-cohort in which optical coherence tomography (OCT) markers of lesion activity was investigated was made up of 321 eyes (12.1%) and the retreatment criteria sub-cohort consisted of 301 eyes (11.4%) (Fig. 1)
Summary
Neovascular age-related macular degeneration (nAMD) is a late-stage manifestation of a chronic degenerative disease affecting the macular retina [1, 2]. A number of small studies have explored potential explanations for this decline in VA by examining anatomic indicators of disease activity detected on OCT and have identified subretinal fluid (SRF) and intraretinal fluid (IRF) at baseline as possible biomarkers for better and worse treatment outcomes, respectively [13,14,15,16,17,18]. In line with these observations, nAMD guidelines from key professional bodies recommend using OCT-based criteria as markers of lesion activity [8, 19,20,21]. The secondary objective was investigated in a sub-cohort made up of eyes with all retreatment information available at any visit during the anti-VEGF maintenance phase (i.e. months 3–12; the ‘retreatment criteria cohort’; Fig. 1)
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