Abstract
Purpose :
Intravitreal medication dosing for neovascular wet age-related macular degeneration (AMD) is limited to an interval of at least 4 weeks between treatments based on existing clinical trial data and insurance limitations. We assert that a subset of patients with this blinding condition demonstrate a greater reliance on the medication than currently recommended and recognized in order to achieve stability. This study reviews the efficacy and relative safety of treatment with anti-vascular endothelial growth factor (VEGF) agents at consistent high-frequency intervals.
Methods :
This was a single-center multiple physician IRB approved retrospective analysis of patients that received anti-VEGF treatment at intervals of ≤25 days. Patients were given full ophthalmologic examinations, optical coherence tomography (OCT), and treated with bevacizumab, aflibercept, or ranibizumab. Anti-VEGF medication remained consistent throughout dates reviewed. Metrics analyzed include central foveal thickness (CFT), and visual acuity (VA), reported as the logarithm Minimum Angle of Resolution (logMAR). Data was gathered through four initial high-frequency visits for each patient. Baseline measurements were assigned to visits immediately prior to the first instance of high-frequency treatment.
Results :
Twenty eyes received 4 anti-VEGF treatments each, with an average treatment interval of 20 days. Mean CFT improved from baseline 332µm to 242µm. Mean VA improved from logMAR of 0.537 before to 0.477 (Snellen equivalents 20/69 and 20/60 respectively). Ophthalmologic examinations revealed no complications during the span of these treatments.
Conclusions :
These patients with highly exudative wet AMD treated with high frequency anti-VEGF had stabilization of their disease anatomically by 27% and functionally by vision improvement of 1 line. Most importantly, initiating high-frequency anti-VEGF dramatically reduced risk of visual loss. This data supports the use of high frequency anti-VEGF in a subset of wet AMD patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.