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Susan Vitale, Elvira Agron, Tiarnan Keenan, Traci E Clemons, Emily Y. Chew; Visual acuity outcomes in eyes treated with anti-VEGF injections during the Age-Related Eye Disease Study 2 (AREDS2). Invest. Ophthalmol. Vis. Sci. 2018;59(9):6013.
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To determine the long-term visual acuity (VA) outcomes following treatment with anti-vascular endothelial growth factor (VEGF) agents for neovascular age-related macular degeneration (AMD) in participants who were enrolled in the AREDS2 study, a clinical trial of oral supplements for the treatment of AMD.
AREDS2 participants had baseline and yearly study visits that included color fundus photography and best-corrected VA. The photos were graded centrally for AMD. Late AMD was defined as central geographic atrophy or neovascular AMD. Between annual study visits, participants were contacted by telephone to obtain a detailed history of treatment for AMD. We pooled ranibizumab, bevacizumab, or aflibercept injections and recorded the number of anti-VEGF injections. We included eyes with following baseline characteristics: no history of anti-VEGF treatments, no late AMD, and VA of 74 letters or better (Snellen equivalent of 20/32). At least one anti-VEGF treatment was given during study follow-up.
A total of 825 eyes (751 participants) were analyzed; mean age was 74.1 y and 62.4% were female. Baseline VA ranged from 74-95 letters (20/32 or better vision); mean VA was 82.4 letters (20/25). By year 5, the average total number of anti-VEGF injections per eye was 11.1 (range, 1-48). The average number of anti-VEGF injections per year ranged from 2.59 to 4.52.The average decrease in VA from baseline in these treated eyes was 8.7, 11.3, 11.0, 13.2, and 12.2 letters for years 1, 2, 3, 4, and 5, respectively. For years 1, 2, 3, 4, and 5, the proportion of eyes that lost 3 or more lines of VA relative to baseline was 19.3%, 27.1%, 26.5%, 34.4%, and 31.8%; the proportion of eyes with 20/200 or worse VA was 4.4%, 6.9%, 3.9%, 6.3%, and 5.8%; and the proportion of eyes that maintained 20/40 or better VA was 75.6%, 71.5%, 67.3%, 62.8%, and 65.7%, respectively.
Treatment with anti-VEGF agents resulted in 62 to 75% of treated eyes maintaining 20/40 or better VA over a 5-year period. However, between 1 in 5 and 1 in 3 eyes lost 3 or more lines of VA. Further examination of factors related to efficacy of anti-VEGF treatment for neovascular AMD is warranted.
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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