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James Talks, Sobha Sivaprasad; Intravitreal aflibercept for neovascular AMD in the very elderly neovascular AMD patients: UK Multi-centre Real World Outcome. Invest. Ophthalmol. Vis. Sci. 2017;58(8):911.
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Data capturing real-life effectiveness of anti-VEGF therapy in very elderly patients with neovascular AMD (nAMD) is limited. We evaluated age-categorized outcomes over 2 years from a national multi-centre audit exploring real world use and effectiveness of intravitreal aflibercept in the treatment of nAMD.
A retrospective study of outcome data from an anonymised electronic medical record database from the 17 NHS centers in the UK Aflibercept Users Group. Data is collected continuously. Data cut off for this analysis was November 2016. nAMD patients treated with aflibercept were categorized by baseline age: ≤ 90 years Group A, (8588 eyes baseline; 4731 year 1 and 2126 year 2) and ≥ 91 years Group B, (739 eyes baseline; 324 year 1 and 131 year 2).
Mean change in ETDRS visual acuity (VA) letter score from baseline to 52 weeks was +4.5 for Group A (baseline VA 54.7) and +4.1 for Group B (baseline 50.2). In first-treated eyes of patients aged ≥91 years, the mean VA at baseline, weeks 52 and 104 were 48.5 (505 eyes), 51.4 and 47.9, respectively. Second-eye mean VA at baseline, weeks 52 and 104 were 59.2 (112 eyes), 65.0, and 64.8, reflecting a VA improvement of 5.8 letters at week 52 and 5.6 at week 104. For Group A, the proportion of eyes gaining ≥15 ETDRS letters from baseline was 19.2% at week 52 and 20.5% at week 104. For Group B, a VA gain of ≥15 letters was achieved in 17.6% and 23.1% at week 52 and week 104. The proportion of eyes losing ≥15 letters from baseline at week 52 and week 104 was 7.7% and 13.0%, respectively, for Group A, and 6.1% and 14% for Group B. The mean number of injections and visits through year 1 and year 2 was slightly lower in Group B. Mean annual injection frequency was 5.7 and 2.6 for Group B vs. 6.2 and 3.3 for Group A in year 1 and year 2, respectively; the mean number of annual visits was 7.3 and 6.2 for Group B and 7.9 and 7.1 for Group A
Retrospective audit results from routine clinical practice suggest patients aged 91 years or more, making up 8.6% of eyes treated, typically present with poorer starting vision, but can do as well as younger patients with regard to mean change in BCVA and preservation of vision with intravitreal aflibercept treatment. Interestingly, we observed that 80% of the treated eyes were first affected eyes in the age group over 91 years.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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