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Weilin Song, Nathaniel B. Rieveschl, Ang Li, Thais Conti, Grant L Hom, Rishi P Singh; Macular Atrophy Affecting Visual Outcomes in Patients Undergoing Anti-VEGF Treatment. Invest. Ophthalmol. Vis. Sci. 2019;60(9):110.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal anti-vascular endothelial growth factor (VEGF) injection is the mainstay treatment for neovascular age-related macular degeneration (nAMD), but there is variability in individual response to therapy. The primary objective of this study was to explore how macular atrophy (MA) at baseline affects visual acuity (VA) outcomes in nAMD patients receiving anti-VEGF injections.
This was a retrospective case control series of patients with a history of treatment-naïve nAMD. Patients were grouped into three cohorts based on baseline OCT image findings of the study eye: foveal MA, non-foveal MA, and no MA. VA outcomes were assessed at 1, 2, and 3 years following anti-VEGF therapy and compared between groups. Automated identification of atrophy area was performed by retinal pigment epithelium sub-illumination analysis with manual correction of segmentation errors. Growth of atrophy was compared between groups after adjusting for baseline lesion size. Post-hoc comparisons were performed using ANOVA models at a Bonferroni corrected significance level of 0.0167. Trends in response over time on BCVA and MA were compared using linear mixed effect models that were adjusted for baseline differences.
A total of 75 eyes, 20 with foveal MA, 26 with non-foveal MA, and 29 with no MA at baseline, were included. By three years, there was no difference in MA growth between eyes with foveal and non-foveal MA (0.88mm2 [95% CI, 0.64, 1.13] vs. 0.88mm2 [95% CI, 0.71, 1.0]) after adjusting for baseline lesion sizes. Patients with foveal MA at baseline averaged a loss of 18.4 ETDRS letters [95% CI, -29.3, -7.6] after three years, while patients with non-foveal MA eyes averaged a gain of 0.97 ETDRS letters [95% CI, -6.94, 8.9], and patients without MA averaged a gain of 9.7 ETDRS letters [95% CI, 5.6, 13.8].
In patients with nAMD receiving anti-VEGF, presence of baseline foveal MA was associated with significant vision loss. Understanding the impact of baseline foveal MA on nAMD therapy outcomes is valuable because it may direct changes to the therapeutic approach for patients while also guiding prognosis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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