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Andrew A Moshfeghi, Ehsan Rahimy, Nick Boucher, Steven Sherman, Fabiana Q Silva, Hadi Moini, John D Pitcher; Real-World Management of Neovascular Age-Related Macular Degeneration in the US. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3123.
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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.
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.
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.
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.
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