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J. R. Jackson, G. S. Hageman, D. D. Saggau, C. H. Barnes, R. J. Rothman, R. M. Tarantola, K. M. Gehrs; Response to Intravitreal Anti-VEGF Therapy in Individuals With Advanced Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):920.
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To evaluate the visual benefit of anti-vascular endothelial growth factor (VEGF) treatment of advanced stage exudative age-related macular degeneration (AMD) with disciform scarring and/or visual acuity (VA) less than or equal to 1.0 LogMAR (20/200). Randomized prospective clinical trials of anti-VEGF therapy for exudative AMD typically have excluded subjects with disciform scarring and/or VA less than 1.0 LogMAR at initial presentation. Yet clinicians often encounter patients with this clinical presentation, and because there are no recommendations from randomized trials with these inclusion criteria, the decision to treat or observe such eyes is based on anecdotal experience and/or physician and patient preference. We sought to determine in a retrospective analysis whether anti-VEGF treatment in the setting of advanced AMD with poor visual acuity yielded any visual benefit when compared to observation.
Patients were recruited from three vitreoretinal practices. Study patients’ eyes were considered independently as intervention was individualized to each eye. Eyes were included which had disciform scarring or VA less than or equal to 1.0 LogMAR at initial presentation. Each eye was followed for a minimum of 12 months, and Snellen VA was measured at each follow-up visit. VA was then converted to LogMAR to eliminate variation among Snellen charts. LogMAR VA at initial presentation and at 12 months follow-up for the control group of 98 untreated eyes and the treatment group of 30 eyes treated with intravitreal anti-VEGF injections were compared by Wilcoxon rank sum test.
Initial VA was not significantly different between the control (1.3985 LogMAR) and treatment (1.1573 LogMAR, p=0.66) groups. VA at 12 months for the treatment group (0.7401 LogMAR) was significantly improved over the control group (1.3742 LogMAR, p=0.0008). This corresponds to an improvement of roughly four lines of vision on a standard Snellen chart for the treatment group, while VA for the control group remained static.
Intravitreal anti-VEGF therapy is effective in significantly increasing VA in eyes with advanced stage exudative AMD as compared to observation alone. Clinicians are encouraged to consider this when making treatment decisions for those eyes presenting with disciform scarring or VA less than 20/200 at initial presentation.
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