Abstract
Purpose :
Neovascular age-related macular degeneration (nAMD) often presents with rapid central vision loss. In many pivotal trials for nAMD and anti-vascular endothelial growth factor (anti-VEGF), the inclusion criteria required visual acuity (VA) to be 20/40 or worse. There is a lack of literature characterizing nAMD presenting with a baseline VA of 20/20. We aim to describe clinical characteristics and treatment outcome of nAMD eyes with 20/20 vision at 3-years follow up during anti-VEGF monotherapy.
Methods :
Retrospective study involving nAMD patients with baseline 20/20 vision with 3 years of follow-up from 2011 to 2021 at a single tertiary hospital system. Eyes that had received anti-VEGF therapy at an outside hospital, had a history of vitrectomy, or follow up less than 3 years were excluded. Clinical data was collected for the eye of interest and the fellow eye including demographic information, VA, systemic and ocular history, and anti-VEGF therapy information. Statistical analysis was conducted for differences between baseline and 3 year follow-up.
Results :
Fifteen nAMD eyes with 20/20 baseline VA from 15 patients were included in this study. Average age was 76±9.1 years with 9 (60%) female eyes and 6 (40%) male eyes. From Baseline to Year 1, 11 eyes (73%) underwent anti-VEGF therapy and at Year 3, 9 (60%) eyes were undergoing anti-VEGF therapy. Mean anti-VEGF injections were 3.9±2.3 Year 1, 5.3±2.4 Year 2, and 4.8±2.9 Year 3. Mean logMAR was 0 (20/20) at Baseline, 0.05±0.07 (20/20) at Year 1 (p<0.05), 0.13±0.14 (20/27) at Year 2 (p<0.05), and 0.11±0.12 (20/26) at Year 3 (p<0.05). Thirteen (87%) of nAMD eyes had VA >20/40 at end of 3-year follow-up; six (40%) eyes remained 20/20, seven (47%) were 20/25-20/30, one was 20/40, and one was 20/50. Mean logMAR for the fellow eye of these patients at baseline was 0.19±0.46 (20/31). Among these fellow eyes, 5 eyes had active nAMD with mean VA of 0.49±0.74 (20/62) and required anti-VEGF therapy. These 5 fellow eyes remained wet AMD at 3-year follow-up, with VA of 0.49±0.74 (20/62) at 3-year follow-up. The remaining 10 fellow eyes had dry AMD that remained dry through the 3-year follow up.
Conclusions :
A total of 40% eyes with nAMD presenting with 20/20 VA maintained 20/20 at three year follow-up with anti-VEGF monotherapy. Future research includes further analysis of imaging characteristics and correlation with predictive factors.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.