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

Abstract

Purpose : The introduction of anti-VEGF for neovascular AMD has been a pivotal change in therapy for macular disease. Randomized clinical trials have shown efficacy up to 2 years of treatment, but data about long-term outcomes and side effects are scarce. With many patients needing lifelong treatment and the trend to individualized treatments (treat and extend) with various agents (bevacizumab, ranibizumab, aflibercept) it is crucial to outweigh the benefits and possible risks of different treatment approaches

Methods : A retrospective cohort study of all patients undergoing intravitreal therapy for neovascular AMD with at least 5 years (± 2 months) of follow-up (2007 to 2017) was carried out through an automated batch data export from the Moorfields Electronic Medical Record system, OpenEyes. Visual acuity was recorded in ETDRS letters. Missing values were sought from the electronic record and manually added. Patients received either aflibercept or ranibizumab, depending on the protocol in effect on day of injection. Statistical analysis was carried out using SPSS version 23

Results : A total of 950 eyes from 722 patients (63.7% female) that completed the 5 year follow-up were included. Mean age (SD) at beginning of treatment was 77 (±8) years. Mean follow-up time for those eyes was 6.4 years (range 4.8-9.7). Sixty-seven eyes (7.1%) had ranibizumab only, and 883 eyes (92.9%) switched from ranibizumab to aflibercept during the data collection period. There were no patients receiving aflibercept only for the whole 5year-period. Baseline visual acuity was recorded in 97% and had a mean (SD) of 59 (±23) letters. Mean (SD) visual acuity at 5 years was 60.4 (±17) letters. Of the eyes included, 19.2% had an improvement of >= 15 letters at 5 years, and 62.7% of eyes maintained a visual acuity within 15 letters of the baseline. Over 5 years, 18.1% of eyes lost 15 or more letters. A mean (SD) of 26 (±10) injections were given over the course of 5 years (7 in the first year, 5 in the second and third year, and 9 from year 3 to 5).

Conclusions : Long-term outcomes over 5 years under anti-VEGF therapy are promising and mostly maintain visual acuity compared to baseline. Automated assessment of retinal optical coherence tomography would provide further insight into disease course. There might be features in this imaging modalities, which are predictors of response to therapy

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