Neovascular Age-Related Macular Degeneration Disease Quiescence with Visual Acuity Stability in a Subgroup of Patients Following PRN Treatment.

Abstract

This study evaluates long-term visual acuity (VA) outcomes in patients with prolonged clinically quiescent neovascular age-related macular degeneration (AMD) after treatment with a pro re nata (PRN) regimen of anti-vascular endothelial growth factor agents (bevacizumab, ranibizumab, and/or aflibercept). This retrospective study analyzes VA changes in 105 eyes from 72 patients with a period of AMD disease quiescence (determined by retinal examination) not requiring treatment for at least 180 days. All patients were seen at Colorado Retina Associates between October 31, 2005 and December 31, 2015. VA was measured at the time of first treatment, last treatment, and final clinic visit showing changes in VA during the treatment and quiescent periods. The sample was stratified to compare those with VA gain throughout the study to those with VA loss. The aggregate group showed VA stability during the treatment period (20/117 to 20/116) with a significant decline during the quiescent period (to 20/235; P < 0.001). The VA gainers had a significant increase in VA during the treatment period (20/187 to 20/88; P < 0.001) and VA stability during the quiescent period (to 20/93). VA losers had a significant decline in VA during both the treatment and quiescent periods (P < 0.001). Overall, PRN treatment resulted in a decline in VA during a period of apparent disease quiescence. There is a group of patients that does not lose VA during this period, and if patients like these can be identified, their treatment could be optimized to include a period of clinically justified nontreatment.