June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Long-Term Outcomes of Patients with Neovascular Age-Related Macular Degeneration Receiving Anti-Vascular Endothelial Growth Factor Treatment: Data from a Single Tertiary Center
Author Affiliations & Notes
  • Anam Akhlaq
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Neslihan Dilruba Koseoglu
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Yuxuan Liu
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Kareef Ullah
    Johns Hopkins University, Baltimore, Maryland, United States
  • Yujie Zhao
    Johns Hopkins University, Baltimore, Maryland, United States
  • Madeleine S Gastonguay
    Johns Hopkins University, Baltimore, Maryland, United States
  • T. Y. Alvin Liu
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Anam Akhlaq None; Neslihan Dilruba Koseoglu None; Yuxuan Liu None; Kareef Ullah None; Yujie Zhao None; Madeleine Gastonguay None; T. Y. Alvin Liu None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2207. doi:
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      Anam Akhlaq, Neslihan Dilruba Koseoglu, Yuxuan Liu, Kareef Ullah, Yujie Zhao, Madeleine S Gastonguay, T. Y. Alvin Liu; Long-Term Outcomes of Patients with Neovascular Age-Related Macular Degeneration Receiving Anti-Vascular Endothelial Growth Factor Treatment: Data from a Single Tertiary Center. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2207.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To report 5-year outcomes of patients with neovascular age related macular degeneration (NVAMD) receiving anti-vascular endothelial growth factor (anti-VEGF) treatment at a tertiary care center.

Methods : This retrospective chart review included 1060 eyes of 833 NVAMD patients who received at least one intravitreal anti-VEGF injection and had at least 5 years of follow up at the Wilmer Eye Institute. Clinical variables including visual acuity (VA) and type/number of anti-VEGF injections were collected; VA values were converted to logMAR for analysis. Descriptive statistical analysis was performed and medians with interquartile range (IQR) calculated.

Results : The median (IQR) age of the patients was 78.25 (71.25-88.83) years at time of the first injection. During a follow-up of 85.13 months (median, IQR: 73.47-100.18), patients received 23 (median, IQR: 11-40) injections. Median time interval between injections was 2.58 (IQR: 1.78-4.13) months. Median VA at the 1st and 7th injection was both 0.39 logMAR (Snellen 20/50; 65 ETDRS letters) but decreased to a median of 0.54 logMAR (Snellen 20/70; 57 ETDRS letters) at the time of last injection. At the time of last injection, 61.4% of eyes had VA within 15 ETDRS letters of the presenting vision. Of the 1060 eyes, 629 (59.3%) were treated with the same anti-VEGF medication throughout the duration of follow up. Of these 629 eyes, 411 received aflibercept (65.3%), 131 received bevacizumab (20.8%) and 87 received ranibizumab (13.9%). Of the 431 eyes that switched anti-VEGF medications at some point, a median (IQR) of 6 (3-11.5) injections were given before the switch, and the most commonly administered drug after the switch was aflibercept (n=319) followed by bevacizumab (n=58) and ranibizumab (n=54).

Conclusions : Our study presents one of the largest single center patient cohorts with long term outcomes. Our results showed that despite initial stabilization as evidenced by similar VA at the 1st and 7th injection visit, only about 60% of eyes remained within 15 ETDRS letters of the presenting VA. This suggests that long term visual acuity outcomes of eyes with NVAMD are worse than those reported in clinical trials, and the gradual decline in vision is likely driven by multiple factors, such as loss to follow up, undertreatment, and/or development of atrophy and fibrosis.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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