June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Characteristics of eyes with neovascular age-related macular degeneration with baseline visual acuity >20/30 and significant vision loss after 3 years of anti-VEGF therapy
Author Affiliations & Notes
  • Jeffrey Chen
    University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Jonathan Hwang
    University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Baraa Nawash
    University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Joshua Ong
    University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Jay Chhablani
    University of Pittsburgh Department of Ophthalmology, Pittsburgh, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Jeffrey Chen None; Jonathan Hwang None; Baraa Nawash None; Joshua Ong None; Jay Chhablani Salutaris, Allergan, Novartis, Erasca, Code I (Personal Financial Interest)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, OD89. doi:
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      Jeffrey Chen, Jonathan Hwang, Baraa Nawash, Joshua Ong, Jay Chhablani; Characteristics of eyes with neovascular age-related macular degeneration with baseline visual acuity >20/30 and significant vision loss after 3 years of anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2023;64(8):OD89.

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

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Abstract

Purpose : Research has shown early treatment for age-related macular degeneration (nAMD) with anti-vascular endothelial growth factor (anti-VEGF) yields improved preservation of vision; however, limited literature on poor treatment outcomes for patients with good baseline vision are available. Herein, we characterize the clinical and imaging findings of a unique subset of nAMD eyes with a best corrected visual acuity (BCVA) of 20/30 or better with significant vision loss after 3 years of anti-VEGF therapy.

Methods : Retrospective review of nAMD patients with BCVA of 20/30 or better was done. Eyes that lost more than 3 Snellen lines of vision after 3 years of anti-VEGF therapy were included. Data was collected on BCVA, central macular thickness (CMT), choroidal neovascularization (CNV) characteristics, subfoveal choroidal thickness (SCT), subretinal fluid (SRF), intraretinal fluid (IRF), and pigment epithelial detachment (PED). Wilcoxon signed-rank test was used for statistical analysis.

Results : A total of 14 eyes (14 patients) out of 74 eyes (69 patients) fulfilled the criteria. Mean anti-VEGF injections over 3 years was 4.79 ± 1.93. Mean logMAR changed from 0.13 ± 0.07 (BCVA = 20/25) at baseline to 0.95 ± 0.71 (BCVA = 20/160) after 3 years (p<0.05). SRF and IRF was present in 10 (71.4%) and 5 eyes (35.7%) respectively. Causes of vision loss include RPE tears (35.7%), foveal atrophy (14.3%), and subretinal hemorrhage (7.1%). Mean CMT was 296.50 ± 42.16 at baseline and 239.18 ± 25.60 after 3 years (p>0.05). CNV type was 8 mixed (57.1%) and 2 type 1 (14.3%). Mean CNV length was 1881.55 ± 678.02 at baseline and 1927.2 ± 1035.32 after 3 years (p>0.05). Baseline CNV location was 9 subfoveal (64.3%), 4 juxtafoveal (28.6%), and 1 extrafoveal (7.1%). 5 eyes (35.7%) expanded their CNV zone after 3 years. Mean SCT was 161.73 ± 63.85 at baseline and 191.70 ± 77.36 after 3 years (p>0.05). PED type was 5 fibrovascular (35.7%), 5 drusenoid (35.7%), and 1 serous (7.1%) after 3 years.

Conclusions : Common causes of significant vision loss in this subgroup were RPE tears, foveal atrophy, and subretinal hemorrhage. Characterization of nAMD eyes with poor clinical outcomes after anti-VEGF therapy may help elucidate predisposing risk factors and underlying eye pathologies associated with poor treatment response.

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

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