Evolution of macular atrophy in eyes with neovascular age-related macular degeneration treated with anti-VEGF agents compared to fellow dry AMD eyes

Abstract

Purpose : Macular atrophy (MA) is a basic characteristic of age-related macular degeneration (AMD), in both its neovascular and dry form. The purpose of this study is to evaluate the evolution of MA in patients with neovascular AMD (nAMD) treated with anti-vascular endothelial growth factor (anti-VEGF) agents, compared with the fellow eyes exhibiting dry AMD.

Methods : Participants in this retrospective study were 124 patients, treated for nAMD with anti-VEGF injections in one eye and followed-up for dry AMD in the fellow eye, in three different retinal departments. We analyzed data of 60 patients with a total of 4 years of follow-up. MA was evaluated in an annual basis using near-infrared and spectral-domain optical coherence tomography images, according to criteria proposed by the Classification of Atrophy Meetings group. Incidence and progression of MA were evaluated.

Results : Presence of MA until the 4^th year of follow up in treated eye (TE) was recorded in 56% (34/60) patients and 30% (18/60) in fellow eye (FE). Repeated measures ANOVA with 2 within factors [time with 5 levels (0 to 4 years) and eye with 2 levels (TE, FE)] revealed significant time (p<0.001), eye (p=0.012) and time-eye interaction (p<0.001) effects. Treated eye MA exhibits a steady significant increase up to year 4, whereas in the FE the significant increase is halted at year 2. The annual increase in the TE is 0.107mm/y for year 1, jumps to 0.304mm/y for year 2 and to 0.343mm/y for year 3, to drop to 0.281mm/y for year 4. The respective annual increase for the FE is 0.143mm/y, 0.143mm/y, 0.092mm/y and 0.086mm/y. Focusing on the subset of the 22/60 patients, who started with no baseline MA in TE, we observed the previously described pattern in a more pronounced manner. Following a slower growth in the TE at year 1 (0.066mm/y vs 0.147mm/y), MA growth in the TE is much faster than the FE (0.388mm/y vs 0.155mm/y for year 2, 0.39mm/y vs 0.083mm/y for year 3 and 0.353mm/y vs 0.075mm/y for year 4).

Conclusions : In this study we documented a significant difference in MA incidence and progression in eyes treated for nAMD compared to their fellow eyes exhibiting dry AMD. Treated nAMD eyes tend to develop more often MA; moreover MA progresses in a faster rate in these eyes compared to fellow dry AMD eyes.

This is a 2021 ARVO Annual Meeting abstract.