Abstract
Purpose :
We were interested in understanding which factors determine relatively poor 5-years outcome of anti-VEGF treatment of AMD in a real-life setting as compared to prospective studies. We investigated if there is a subpopulation in our real-life data that has a significanty better 5-years outcome by stratifying by disease stages, number of injections, access to treatment an adherence to treatment.
Methods :
This is a retrospective analysis of 1500 cases of neovascular AMD being treated according to a PRN scheme between 2010 and 2014. Letter scores for a period of up to 5 years have been evaluated as well as number of injection in each year. Visual acuity at baseline served as a marker for disease stage at baseline, the interval between visits as a marker for adherence to therapy. At a certain time access to treatment was greatly facilitated by introducing a general treatment allowance for the public healthcare system. Accordingly, subgroups have been defined as earlier disease stages, higher number of injections, faster access to treatment and adherence to treatment.
Results :
In the overall population the initial gain in letter score is reverted by end of year 2. The subgroups with high injections and earlier disease stages have both a significantly better outcome, however by year 3 there is also a loss below baseline. Ease of access to treatment clearly improves the initial gain, where a second upturn in letter score after the initial upload is observed. Only the group with good adherence to treatment, however, continues to have a positive letter score over 5 years.
Conclusions :
More than the stage of disease do adherence to treatment and access to treatment determine long term outcome in anti-VEGF treatment in AMD in a PRN setting.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.