Abstract
Purpose :
The Treat-and-Extend (T&E) regimen with anti-VEGF agents is often used by retina specialists in clinical settings in the treatment of neovascular age-related macular degeneration (nAMD). This study evaluated the real-world long-term eight-year visual acuity outcomes of regular intravitreal anti-VEGF agents in patients with nAMD in the United States.
Methods :
This is a retrospective, interventional, consecutive case series. 165 eyes from 137 treatment-naïve patients diagnosed with nAMD after August 2010 were treated at a single site by one physician with ranibizumab, aflibercept, bevacizumab, or brolucizumab for ≥1 year using a T&E regimen. Patients needed to receive ≥6 injections in the first year and ≥3 injections in the following years to be included in this study. Snellen best-corrected visual acuity (BCVA) was converted to ETDRS letters using a standardized formula. The main outcome measures were: BCVA change from baseline to end of patient follow-up; mean number of injections per year, and percentage of eyes losing ≥15 letters, gaining ≥15 letters or maintaining vision within 15 letters.
Results :
The average (standard deviation [SD]) baseline patient age was 78 years (8.5); 60% of patients were female. The mean follow-up period was 5.4 years, with 165, 158, 143, 126, 102, 78, 48, and 26 eyes completing 1, 2, 3, 4, 5, 6, 7, and 8 years of follow up, respectively. The average BCVA at baseline was 53 letters. Mean (SD) changes from baseline in BCVA were 8.3 (21.8) letters, 7.1 (25.0) letters, 4.7 (26.5) letters, 4.5 (27.1) letters, 4.5 (28.3) letters, 5.1 (26.5) letters, and -0.5 (34.8) letters and -4.3 (38.9) letters for years 1-8 respectively. Mean number of injections during years 1-8 were 7.9, 6.1, 5.8, 6.0, 6.2, 5.9, 6.2, and 6.0, respectively. At the final follow-up, 24.2% of eyes had lost ≥15 letters, 26.1% of eyes had gained ≥15 letters and 49.7% of eyes had maintained vision within 15 letters.
Conclusions :
75.8% of patients on the T&E regimen either maintained or improved their vision at the final follow up. The T&E regimen has been effective in maintaining visual acuity in nAMD patients treated with ranibizumab, aflibercept, bevacizumab, or brolucizumab for up to six years of treatment. Patients lost vision in the 7th and 8th year of treatment and further analysis is needed to evaluate the cause of vision loss.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.