One and two-year visual acuity outcomes after treatment for neovascular age-related macular degeneration at a large tertiary ophthalmic hospital

Abstract

Purpose : Age-related macular degeneration (AMD) is the leading cause of severe visual impairment in the developed world. The management of neovascular AMD (nAMD) has been transformed by the emergence of intravitreal anti-VEGF therapy, most powerfully demonstrated by pivotal trials including ANCHOR, MARINA, and VIEW. However, such trials may not reflect a real-world case mix rendering the visual outcomes unrepresentative. Here, we report on the visual outcomes within the first 24 months following commencement of intravitreal therapy in a large tertiary single-centre ophthalmic hospital.

Methods : A retrospective cohort study of all patients undergoing intravitreal therapy for nAMD from 2007 to 2017 was carried out through an automated batch data export from the Moorfields Eye Hospital Electronic Medical Record system, OpenEyes. Patients were treated by aflibercept or ranibizumab, depending on the guidelines at first injection. All data was checked for consistency and completeness. Statistical analysis was carried out using SPSS version 23.

Results : A total of 6,882 eyes from 5,614 patients (61.4% female) were included. Mean (SD) age at first injection was 79 (±8.6) years. Two-thousand one-hundred and forty-seven patients (31.2%) were injected with ranibizumab, 2,516 (36.6%) with aflibercept and 2,219 (32.2%) switched between agents during the data collection period. Mean (SD) baseline visual acuity was 55.6 (±16) letters. Mean (SD) visual acuity at 12 months and 24 months was 62.18 (±17) and 62.8 (±16) letters respectively. A mean (SD) of 7.5 (±2) injections were given during the first year, and 12.5 (±4) injections were given over the 24 month period. Of the eyes included, 18.8% and 20.5 % had an improvement of >= 15 letters, 72.4% and 68.4% of eyes maintained a visual acuity within ±15 letters of the baseline, and 8.8% and 11.1% of eyes lost 15 or more letters, at 12 months and 24 months respectively.

Conclusions : As per the pivotal trials, the majority of patients maintained their vision upon commencement of treatment although visual acuity gains were more modest. This is probably due to several reasons influencing outcomes of nAMD treatment in real-life (e.g. therapeutic adherence or accessibility of care). Compared to UK patients of a multi-country real-life study (Holz et al., 2015), our cohort had similar outcomes.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.