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Greg D Fliney, Leonid Zukin, Curtis Hagedorn; Wet AMD Quiescence with Visual Acuity Stability in a Sub-Group Following PRN Treatment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):898.
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© ARVO (1962-2015); The Authors (2016-present)
Little is known about the effect of clinically justified non-treatment on visual acuity (VA) for patients being treated with anti-vascular endothelial growth factor (anti-VEGF) agents for wet age-related macular degeneration (AMD) following a PRN treatment schedule. A retrospective chart review was performed to compare the clinical courses of patients who gained or lost VA overall during such a treatment regimen and find factors predicting a better outcome.
This study consists of 105 eyes (34 male and 71 female) from 72 patients with an average age of 77.3±7.7 years at the time of first treatment. Patients selected for analysis were diagnosed with wet AMD, treatment naïve, treated PRN with Avastin, Lucentis, and/or Eyelea, and had a period of disease quiescence not requiring treatment for at least 180 days. Patients who had VA-altering eye surgery during the study period were excluded. VA was analyzed at the times of first treatment, last treatment, and final clinic visit for comparison between the groups with overall VA gain and loss. Statistical analyses were performed 2-tailed and included one-sample and independent samples t-tests, Pearson correlation, and a post-hoc power analysis.
There was no statistically significant difference between the VA gainers or VA losers with respect to: age, gender, number of treatments, length of treatment, and length of quiescence (p>.05). The average change in VA for both groups are shown below (Figure 1). The VA gainers had a significant increase in VA during the treatment period (p<.001) and VA stability during the quiescent period (δ -.003 decimal units, p=.461; β=.43). VA losers had a significant decline in VA during both the treatment and quiescent periods (p<.001). There was a moderate correlation between VA during the treatment and quiescent phases (ρ=.478, p<.001).
While there were no significant demographic or treatment differences between the two groups, there was a significant difference in their clinical courses. VA stability during the quiescent period for the VA gainers indicates that there is a group of responding patients that might not require continued treatment throughout life. They could possibly be identified early by changes in VA during the treatment period.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1: Data points from left to right correspond with: normalized VA at first treatment, change in VA at last treatment, and change in VA at final visit.
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