Consequences of Lapses in Treatment with Vascular Endothelial Growth Factor Inhibitors in Neovascular Age-Related Macular Degeneration

Abstract

Purpose : Anti-vascular endothelial growth factor (VEGF) injections have revolutionized care in neovascular age-related macular degeneration (nAMD). In practice, it is challenging for patients to maintain appropriate care due to the requisite high frequency of treatment with anti-VEGF. Our study hypothesizes that visual acuity and retinal thickness outcomes are poorer in patients who experience a lapse in treatment with anti-VEGF.

Methods : This IRB approved, retrospective study evaluated 3304 patients ≥18 years of age treated with anti-VEGF for nAMD at Cleveland Clinic Cole Eye Institute between January 1, 2015 and August 1, 2018. Patients with lapses in care of ≥3 months were included while those without a lapse were collected as controls. Patients with confounding maculopathies, treated at outside practices, and those with treatment intervals ≥3 months per provider recommendation (e.g., treat and extend protocol) were excluded. Retinal central subfield thickness (CST) as measured by spectral domain OCT and visual acuity (VA) were collected at baseline, the first post-lapse appointment, and at 3, 6 and 12 month follow-ups. T-tests were used to compare continuous variables, while Pearson Chi-Square and Fisher Exact Tests were used for categorical variables.

Results : Control patients (n=241) and study patients (n=241) had similar baseline CST (259.8±66.2µm vs 252.4±63.2µm, p=0.2116) and VA (59.2±20.1 ETDRS vs 58.9±20.2 ETDRS, p=0.21). Study patients experienced a significant increase in CST after lapse in care when compared to controls (control: 253.7±65.9µm, study: 279.4±86.9µm, p<0.001) which normalized upon resumption of treatment. Study patients also experienced loss in VA after lapse in care (control: 59.9±20.8 ETDRS, study: 52.9±23.6 ETDRS, p<0.001) that did not recover through 12 months of follow-up (Figure 1).

Conclusions : Patients with nAMD that have lapses in care are at risk for poorer outcomes. Though CST normalizes upon resumption of treatment, patients experience a statistically and clinically significant decline in VA that does not recover. These findings support that consistent evaluation and treatment are critical to maintenance of vision in nAMD.

This is a 2020 ARVO Annual Meeting abstract.