Abstract
Purpose :
The aim of the study was to examine real world outcomes of treating Neovascular Age-Related Macular Degeneration(nAMD) at set time points, in a series of patients who had follow up for 10 years.
Methods :
A single centre retrospective review of electronic patient records was done for treatment naïve patients who were diagnosed with nAMD & initiated on anti-VEGF injections at Frimley Park Hospital, UK from 1st Jan 2011 to 31st Dec 2011.
The patients were initiated with IVI Ranibizumab(0.5mg) based on NICE criteria or IVI Bevacizumab(1.25) at that time. At each visit, best corrected visual acuity using Early Diabetic Retinopathy Study letters, slit lamp examination & OCT were performed.
The primary end point was change in visual acuity(VA) at loading dose, 5th year & 10th year visit. Secondary outcomes included percentage of VA better than 70 letters, VA loss and anatomical outcomes. Results were compared to 7-year outcomes in ANCHOR & MARINA (SEVEN UP study).
Results :
356 eyes of 342 treatment naïve patients were analysed, of which 32.8%(117) completed 10-year follow-up. Of the 117 eyes, 32.4% initially started on IVI Bevacizumab 67.5% eyes were started on IVI Ranibizumab.
Mean gain in VA was +4.28 letters at 3rd visit with a mean decline in VA of 10.28 letters at 5 years & 17.3 letters at 10 years.
22.22% met the secondary end point of 70 letters or better VA after treatment for 10years (compared to 37% in 7-year ANCHOR or MARINA study)
30.7% of eyes had vision loss of over 15 letters over 5year period & 47.8% had vision loss of over 15 letters over 10 years period (compared to 37% in 7-year ANCHOR or MARINA study). Amongst these eyes, main cause of visual loss was macular scarring (17.8%), 12.5% eyes had geographic atrophy, rest 69% other ocular causes. Mean central subfield thickness at baseline was 297.03µm, by 3rd visit it reduced to 274.87um & over 10 years, it increased to 307.39um.
Conclusions :
The study shows more than half the patients had VA better than 50 letters demonstrating anti-VEGF therapy can result in long-term stabilization of visual acuity.
10.2% eyes presented with persistence of disease activty over 10 years signifying the treatment burden. Limitations of this study was small sample size.
Further studies need to be done for 10 year data for better understanding of the disease trend and evaluate the trend causing macular scarring to improve visual gain.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.