Macular atrophy incidence and progression in 5-year treatment of exudative age-related macular degeneration

Abstract

Purpose : To determine how macular degeneration patients undergoing intravitreal anti-VEGF therapy for 5 or more years are affected by the onset and growth of macular atrophy, the loss of photoreceptors and RPE.

Methods : This is a retrospective study of patients with exudative age-related macular degeneration (AMD), utilizing serial optical coherence tomography (OCT) images and near-infrared scanning laser ophthalmoscopy (SLO) images (Heidelberg Spectralis) collected over 5 years. A minimum of two near-infrared images (at 5-7-month intervals) were evaluated for each year that patients were receiving anti-VEGF injections. Images were de-identified and scrambled for masked reading. MA measurements were performed by a semi-automated process using image analysis software (ImageJ). Eyes that showed extensive disciform scarring were excluded.

Results : From a medical center electronic medical record database, a total of 2,862 subjects were identified from June 2012 to August 2019 who had a diagnosis of exudative AMD; from these, 452 had initiated anti-VEGF therapy (ranibizumab, aflibercept, or bevacizumab) with follow-up of at least 5 years and had at least 10 OCT studies performed. Thirteen patients (21 eyes) were selected for this pilot analysis. At the earliest available visit, 17/21 (81.0%) of eyes under treatment had the presence of any degree of macular atrophy, increasing to 19/21 (90.5%) in the second year, and 20/21 (95.2%) in the fifth year. At baseline, the mean MA area for all 21 eyes was 1.26 mm² (±2.20 SD), while the mean MA area at year 5 was 5.24 mm² (±6.60 SD). The MA area increased at an average rate of 0.71 mm² (±0.35 SD) per year, with a 0.42 mm² (±0.84 SD) area increase in year one, 0.82 mm² (±1.37 SD) increase in year three, and a 0.98 mm² (±1.91 SD) increase in year five. Over the period of treatment, the total increase in MA lesion size from baseline through year five was 316%.

Conclusions : In the long-term treatment of exudative AMD with intravitreal anti-VEGF agents, macular atrophy has a high incidence and demonstrates a steady progression in lesion size over 5 years. OCT and SLO near-infrared images, ubiquitous in routine retina practice, provide extensive patient data to analyze macular atrophy over the extended course of management.

This is a 2020 ARVO Annual Meeting abstract.