Abstract
Purpose :
To evaluate the management of neovascular age-related macular degeneration (nAMD), factors that predict receiving treatment, and the relationship between treatment frequency and visual outcomes in routine clinical practice.
Methods :
This retrospective analysis assessed electronic medical records from the Vestrum Health Retina Database for treatment-naïve eyes newly diagnosed with nAMD from January 1, 2014 that had ≥1 year of follow-up. Cumulative incidence of eyes receiving treatment was evaluated using the Kaplan–Meier (KM) method, and factors that predicted receiving treatment through one year were evaluated by logistic regression.
Results :
Of 90,681 eyes included in the analysis, the percentage of eyes not receiving treatment was 23%, 16%, 15% and 13% at diagnosis and years 1, 2 and 3, respectively. The mean baseline visual acuity (VA) of eyes not treated and treated were 39 and 52 letters, respectively. Higher odds ratio (OR≥1.50, [95% CI]) of receiving treatment was found for eyes with baseline VA 20/40-20/100 vs ≥20/40 (1.52 [1.44, 1.61]); and for eyes with macular edema (3.26 [3.11, 3.42]), subretinal fluid (4.97 [4.75, 5.20]), or sub-retinal pigment epithelium fluid (1.64 [1.56, 1.72]). Lower OR (OR£0.50) for receiving treatment was found for patients with simultaneous bilateral diagnosis (vs. unilateral diagnosis, 0.32 [0.31, 0.34]);and for eyes with baseline VA<20/400 vs. ≥20/40 (0.29 [0.27, 0.30]). When treated within 1 month from diagnosis, eyes gained a mean (SD) of 5 (3) letters from baseline at 6 months, which was maintained at year 1. If treatment initiation was delayed 6 months from diagnosis, eyes gained a mean (SD) of 1 (0) letter at year 1. Mean BCVA change from baseline at year 1 was −1.21, 0.58, 4.31 and 5.6 letters in eyes treated with 1-3, 4-6, 7-9 and >9 injections, respectively. Within the subgroup of eyes that received 7-9 and >9 injections, those with baseline VA<20/400, gained 20.3 and 27.2 letters, respectively.
Conclusions :
Almost one quarter of eyes with nAMD did not receive treatment at diagnosis. Simultaneous bilateral nAMD diagnosis and poor baseline VA (<20/400) were primary factors associated with not receiving anti-VEGF treatment. Greater VA gains were observed with prompt treatment and increasing number of injections, with eyes with poor baseline vision (<20/400) gaining a mean of ≥4 lines with ≥7 injections from baseline at year 1.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.