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Olga Gkorou, Holly Joan Duncan, Jeffry Hogg, Lydia Grace Stone, Michelle Blyth, Lesley Brandes, Adele Devenport, Leanne Timms, James Stephen Talks; The impact of treatment intensity over 3 years of real-world data of neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2021;62(8):449.
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Neovascular age-related macular degeneration (nAMD) clinical trial data suggest better visual outcomes for patients receiving more intensive aflibercept intravitreal injections (IVIs). Real-world data in nAMD have described more modest outcomes; so it is unclear if there is pragmatic benefit in pursuing greater treatment intensity for individuals, when clinical resources are already limited. This retrospective, observational study aims to describe the effect of IVI frequency on visual outcomes for nAMD patients at different stages of treatment.
Patients, initiated on treatment for nAMD with 3 years of follow up, were identified through our patients' database. The visual acuity (VA) in early treatment of diabetic retinopathy (ETDRS) letters and IVIs frequency were recorded over a period of 3 years. Age, gender, macula fluid, lens status were recorded. Descriptive and comparative statistics were performed with SPSS v.24.
175 eyes (89 left, 87 pseudophakic) from 175 patients (109 female, mean age 79.1 years) with 3 years of continuous treatment were identified. Each eye received a mean (95% confidence interval) of 7.6(7.4,7.7), 5.2(4.9,5.5) and 5.4(5.1,5.7) IVIs to achieve mean VAs of 63.7(61.9,65.5), 61.4(59.4,63.5) and 60.6(58.2,62.9) ETDRS letters over their first, second and third years of treatment respectively. 137 eyes (78.3%) received 3 loading IVIs within 9 weeks to gain a mean 5.6(1.1,13.3) ETDRS letters over their first year of treatment. This was statistically equivocal (p=0.55) to the 4.2(2.2,13.6) ETDRS letters gained by eyes experiencing loading delays. Univariate logistic regression found that completing loading within 9 weeks had no statistically significant power to predict the absence of retinal fluid 1 year after treatment started(p=0.46). Univariate linear regression found that annual IVI frequency had statistically significant power to predict VA gain over the first (unstandardised B=3.8 (0.2,7.4), p=0.036) and second years of treatment (unstandardised B=0.7 (0.0-1.3), p=0.038), but not the third (p=0.31).
A significant increase in visual gain was noted in the first year of treatment for eyes receiving more IVIs in our data. The visual outcomes of second and third years of treatment appear less sensitive to treatment frequency. In a resource limited environment, patients in their first year of treatment should be prioritised.
This is a 2021 ARVO Annual Meeting abstract.
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