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Mark C Gillies, SANJEEB BHANDARI, Benjamin Wolff, Jennifer Joan Arnold, Rohan W Essex, Stephanie Young, David M Squirrell, Daniel Barthelmes, Vuong Nguyen; Ten-Year Treatment Outcomes of Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2019;60(9):111. doi: https://doi.org/.
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Phase 3 clinical trials have established that intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors were beneficial for neovascular age-related macular degeneration (nAMD) in the short term. Many eyes with nAMD in real world clinical practice have now been receiving treatment for over ten years. We report outcomes over ten years of treatment with anti-VEGF for nAMD.
Treatment-naïve eyes with nAMD starting VEGF inhibitor injections at least 10 years prior to the analysis were tracked in the Fight Retinal Blindness! Project outcomes registry. Visual outcomes and treatment practices over 10 years years were compared in the cohorts from Australia & New Zealand (ANZ) and France & Switzerland (EUR).
A total of 712 eyes (ANZ – 402; EUR – 302) were identified. The mean VA in 115 eyes (29%) from ANZ that completed 10 years of continuous treatment dropped by 1.3 letters from baseline (95% Confidence Intervals: 3.1, -5.8) (p=0.56) at 10 years; 44% had VA ≥ 70 letters (20/40), and 13% had VA ≤ 35 letters (20/200). Of those with VA ≥ 20/40 before treatment, 57% maintained this level of vision at 10 years. The mean VA in 53 eyes (17%) from EUR that completed 10 years dropped by 13.3 letters (-6.6, -20.1) (p<0.001) at 10 years; 32% had VA ≥ 70 letters (20/40), and 32% had VA ≤ 35 letters (20/200). Of those with VA ≥ 20/40 before treatment, only 39% maintained this level at 10 years. More eyes with VA ≥ 20/40 at presentation completed 10 years of treatment. Eyes in both ANZ and EUR started with a median of 6 injections in the first year. Eyes in ANZ received a median of 4 injections in the second and third years followed by a median of 5 injections per year thereafter. The median injections in EUR dropped to 3 in the second year and 2 per year from the third to sixth year then rose to an average of 4 injections per year thereafter. Where reasons were supplied, 38% had discontinued treatment for reasons related to poor outcomes. The mean VA of eyes that dropped out deteriorated below the baseline at their final visit. The rate of serious adverse events with intravitreal injections was low.
Visual outcomes in were better in eyes from ANZ, likely because they received more injections. Eyes with better vision tended to continue treatment longer with better visual outcomes. Eyes with nAMD may achieve satisfactory long-term outcomes if they receive adequate treatment.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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