Abstract
Purpose :
To analyze characteristics from the SMR to predict visual acuity (VA) below national treatment criteria ≤ 35 letters of the Early Treatment Diabetic Retinopathy Study (ETDRS) due to nAMD during a two years follow-up.
Methods :
The SMR covers 84% of all patients treated for nAMD in Sweden. This study evaluates 6142 treatment naïve eyes registered from January 1, 2013 to December 31, 2014. Special focus lies on a subgroup of 780 (12.7%) eyes of 774 patients with VA outcome ≤35 letters. We evaluated differences of baseline characteristics, change of VA, number of injections, and choice of drug to predict visual outcome.
Results :
Patients with final VA ≤35 letters were older 80.5± 7 vs 78.7± 8.1 years; p<0.0001, and received fewer injections 6.2± 3.8 vs. 8.7± 5.4; p< 0.00001. They decreased from 53.5±10.6 to 25.4± 12.6 letters; with 10.0± 6.8 months mean time and mean 5.0± 3.0 injections to VA ≤35 letters. The group with final VA >35 letters increased from 58.1± 15.8 to 60.9± 17.4 letters at 2 years. Only 4% of all patients with ≥70 letters baseline VA compared to 17% with baseline VA 36-69 letters ended up with a final VA ≤35 letters.
The two groups with final ≤35 letters and VA >35 letters presented following lesion locations; 61% vs. 57% subfoveal, 18% vs. 21% juxtafoveal, 4% vs. 6% extrafoveal, 17% vs. 16% unknown. Location differed significantly between those groups; p=0.0013. Lesion size, in the group with final VA ≤35 letters, was 2805.5± 2092.7 vs. 2439.7± 1637.3 µm in the group with VA >35 letters.
Interestingly, baseline VA ≤35 letters significantly favored monotherapy with bevacizumab; 34% (n=200) in the group with final VA >35 letters; p<0.0001, 67% (n=4) in the group with final VA ≤35 letters; p=0.0149. In the group with final VA>35 letters, baseline VA of ≥70 letters led preferably to aflibercept treatment; p=0.0011.
Conclusions :
12.7% of all patients presented with a final VA of ≤35 letters. These were older, with larger and more often subfoveal lesions, and received fewer injections than patients with final VA >35 letters. Patients were preferably treated with bevacizumab when presenting with VA ≤35 letters at baseline. Only 4% with baseline VA ≥70 letters dropped to ≤35 letters. The higher the baseline VA, the lower the risk for visual outcome ≤35 letters during the 2-year period.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.