Abstract
Purpose :
To describe factors associated with poor visual acuity (VA) 2 yrs after initial anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (AMD).
Methods :
We studied 549 participants (594 eyes) in the Age-Related Eye Disease Study 2 (AREDS2: a randomized controlled trial assessing the effect of nutritional supplements in individuals with AMD) who received initial anti-VEGF therapy during the course of the study and had baseline VA ≥20/100. AREDS2 included yearly fundus photos graded by masked graders. Fundus photos were reviewed to determine the cause of poor VA (<20/200).
Results :
Mean age was 75 y (range, 50.5-85.9); 59% were female. 56 eyes (9.4%) developed poor VA at 2 yrs following initial anti-VEGF therapy; 538 eyes did not. The major cause of poor VA was central macular atrophy (without subretinal fibrosis) in 60% and central subretinal fibrosis (with or without macular atrophy) in 40%. After multivariable adjustment, factors associated with poor VA at 2 yrs following initial anti-VEGF therapy included non-white race (odds ratio (OR), 9.70; 95% confidence interval (CI), 2.01-46.76), fewer anti-VEGF injections (OR, 0.92 (per additional injection); 95% CI, 0.87-0.97), VA <20/40 at baseline (OR, 6.35; 95% CI, 2.28-17.71), and noncentral GA at baseline (OR, 3.00; 95% CI, 1.29-7.01). AMD-specific genetic risk score was available for about half of participants; we found no associations of risk score with poor VA at 2 yrs following initial anti-VEGF therapy (OR, 0.84; 95%CI, 0.62-1.15). Our observation that the cumulative number of anti-VEGF injections was lower in those with poor VA at 2 yrs following initial anti-VEGF therapy was possibly due to the poor VA group’s greater prevalence of central GA and resultant fibrosis, which might have resulted in a clinical decision to cease giving anti-VEGF injections due to futility; alternatively, relative undertreatment of neovascular AMD may have led to more aggressive disease and subsequent poor VA.
Conclusions :
Most eyes (90.6%) that received initial anti-VEGF therapy during AREDS2 follow-up had VA ≥20/200 2 yrs later. Those with poor VA 2 yrs following initial anti-VEGF therapy had either macular atrophy or subretinal fibrosis and were more likely to be non-white, have worse VA at baseline, to have noncentral GA at baseline, and to have received fewer anti-VEGF injections.
This is a 2020 ARVO Annual Meeting abstract.