July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular AMD Patients: A “Real World” Analysis in 49,485 Eyes
Author Affiliations & Notes
  • Thomas A Ciulla
    Retina, Midwest Eye Institute, Indianapolis, Indiana, United States
    Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • John S Pollack
    Illinois Retina Associates, Chicago, Illinois, United States
    Rush University Medical Center, Chicago, Illinois, United States
  • David Williams
    Vitreo-Retinal Surgery PA, Minneapolis, Minnesota, United States
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 1623. doi:
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      Thomas A Ciulla, John S Pollack, David Williams; Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular AMD Patients: A “Real World” Analysis in 49,485 Eyes. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1623.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Neovascular AMD (nAMD) patients most commonly receive “treat and extend” regimens of anti-vascular endothelial growth factor (VEGF) therapy, instead of fixed interval dosing, in an attempt to limit treatment burden. This analysis assessed anti-VEGF therapy intensity, as well as the relationship between treatment intensity and visual acuity (VA) outcomes, in “real world” nAMD patients, using a demographically diverse sample of U.S. retina specialists’ electronic medical records (EMR).

Methods : Analysis was performed on a large database of aggregated, longitudinal EMR from a demographically diverse sample of U.S. retina specialists. The HIPAA-compliant Vestrum Health Retina Research Dataset was used retrospectively. Treatment naïve nAMD patients who underwent anti-VEGF injections between January 1, 2012 and October 31, 2016 were eligible if follow up data was available through October 31, 2017. VA outcomes were assessed at 1 year and stratified based on number of injections received over 1 year.

Results : 49,485 eyes were included in this analysis. The mean age at initial presentation was 81 years. At 1 year, the mean number of letters gained was 1 letter after a mean of 7.3 injections. There was a linear relationship between mean letters gained and mean number of injections, up to 10 injections over 1 year, after which the relationship plateaued. The mean change in VA was -1.7, -0.4, +2.5, and +3.0 in those 2313, 5250, 6212, and 2134 patients who received a mean of 3, 6, 9, and 12 injections respectively.

Conclusions : This analysis corroborates prior observations that nAMD patients are under-treated and that visual outcomes following anti-VEGF therapy for nAMD in the “real world” do not achieve those seen in randomized controlled trials. This analysis also demonstrates that treatment intensity in the “real world” correlates with visual outcomes over the first year of treatment, and that, on average, current regimens that meaningfully decrease treatment intensity in the first year may result in under-treatment in some patients. This observation highlights the need for more intensive therapy and treatment compliance in nAMD.

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

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