Abstract
PurposeTo report the 36-month treatment outcomes of eyes with neovascular age-related macular degeneration (nAMD) receiving vascular endothelial growth factor (VEGF) inhibitors in daily practice who did not develop either subretinal fibrosis (SRFi) or macular atrophy (MA).MethodsThis is a retrospective analysis of data from the Fight Retinal Blindness registry. Treatment-naïve eyes starting intravitreal injection of VEGF inhibitors for nAMD from January 1, 2010, to September 1, 2017, and did not have SRFI and MA at baseline were tracked.ResultsWe identified 2478 eligible eyes, of which 1712 eyes did not develop SRFi or MA, 291 developed extrafoveal SRFI or MA, and 475 developed subfoveal SRFi or MA over 36 months. The estimated visual acuity stabilized from 6 months to 36 months in eyes that did not develop SRFI or MA with a mean (95% confidence interval [CI]) change in VA of −1 (−2, 0) letters, whereas eyes that developed extrafoveal (−3 [−5, −2] letters) or subfoveal (−10 [−11, −8] letters) SRFi or MA declined in vision in the same period. Eyes with no or extrafoveal SRFi or MA over 36 months were more likely to maintain their visual improvement from six months to 36 months (odds ratio [OR; 95% CI] = 2.3 [1.5, 3.3] for absence vs. subfoveal SRFi or MA, P ≤ 0.01 and OR = 2.0 [1.2, 3.4] for extrafoveal vs. subfoveal MA or SRFi, P = 0.01).ConclusionsTreatment-naïve nAMD eyes receiving VEGF inhibitors maintain their initial six-month visual improvement over three years if they do not develop SRFI or MA.Translational RelevanceThe nAMD is still a major cause of blindness despite antiangiogenic treatments. We found that eyes that did not develop subretinal fibrosis or macular atrophy maintained their initial vision improvement for at least three years, suggesting that identifying treatments for these complications is the final barrier to achieving excellent outcomes in nAMD.
Highlights
The estimated visual acuity stabilized from 6 months to 36 months in eyes that did not develop SRFI or macular atrophy (MA) with a mean (95% confidence interval [CI]) change in VA of −1 (−2, 0) letters, whereas eyes that developed extrafoveal (−3 [−5, −2] letters) or subfoveal (−10 [−11, −8] letters) subretinal fibrosis (SRFi) or MA declined in vision in the same period
Eyes with no or extrafoveal SRFi or MA over 36 months were more likely to maintain their visual improvement from six months to 36 months
We found that eyes that did not develop subretinal fibrosis or macular atrophy maintained their initial vision improvement for at least three years, suggesting that identifying treatments for these complications is the final barrier to achieving excellent outcomes in neovascular age-related macular degeneration (nAMD)
Summary
The end-stage sequelae of neovascular age-related macular degeneration (nAMD), macular atrophy (MA), and subretinal fibrosis (SRFi) increase with time, are untreatable, and are associated with poor visual outcomes.[1,2,3,4,5] Both clinical trials and observational studies tend to find that visual acuity (VA) improves from baseline for six months after starting treatment with vascular endothelial growth factor (VEGF) inhibitors and progressively declines thereafter in association with the development of foveal MA or SRFi, with final vision depending mainly on the presenting VA at the start of the treatment and the number of injections.[6,7,8] Older age, presenting VA, and type of choroidal neovascularization (CNV) may predict risk of progression to MA and SRFi under treatment more strongly than treatment strategy and frequency.[1,9,10] Few studies, if any, have investigated whether there is any other mechanism that causes visual loss in eyes with nAMD independently of these features. We tested the hypothesis that eyes with nAMD treated with VEGF inhibitors continue to lose vision through unknown mechanisms, even if they do not develop SRFi or MA
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