Impact of Time to First Anti-Vascular Endothelial Growth Factor Injection on Visual Acuity in Treatment-naïve Patients with Neovascular Age-Related Macular Degeneration

Abstract

Purpose : Prior studies have examined the frequency and intervals of anti-vascular endothelial growth factor (VEGF) injections in neovascular Age-related Macular Degeneration (nAMD), but few have assessed the impact of time from symptom onset to treatment initiation on visual outcomes, which is the subject of this retrospective chart review.

Methods : Using International Classification of Diseases codes and manual chart review, treatment-naïve nAMD patients presenting to Massachusetts Eye & Ear Emergency Department (MEE ED) from 2009 to October 2023 were identified. Patient demographics, medical history, date of symptom onset and first anti-VEGF injection, anti-VEGF agent, number of injections, and best-corrected visual acuity (BCVA) measurement monthly for the first year, then at 18, 24, and 36 months were collected. Exclusion criteria were cataract surgery during treatment, missing timing of symptom onset, history of other retinal disorders, or prior anti-VEGF therapy. A linear mixed-effects model using R (Ver. 4.3.2) assessed impact of time from symptom onset to first anti-VEGF injection on visual acuity at 6 months, 1, 2, and 3 years.

Results : A total of 42 eyes of 42 patients with treatment-naïve nAMD presenting to MEE ED were reviewed, with a mean 9.88 ± 3.23 (range: 4-17) follow up visits over 3 years. Mean age was 77.50 ± 8.51 years, with 64.3% women. Time from symptom onset to first anti-VEGF injection ranged from 0 to 215 days (mean: 40.21 ± 60.99 days) (Table 1). After adjusting for confounders (age, sex, baseline BCVA, number of injections, medication), interval between symptom onset and initial injection correlated with BCVA outcomes at 1, 2, and 3-year follow-up. Specifically, each additional day in the interval corresponded to a 0.01 increase in logMAR BCVA at 1-year follow-up (p-value < 0.001). Time from ED visit to injection, which was on average 7.7 days (range 0-42), was not significantly associated with BCVA outcomes (Table 2).

Conclusions : Despite our small sample size to date, our results suggest that treatment-naive nAMD patients with longer intervals between initial symptom onset and first anti-VEGF injection may have worse long-term visual outcomes, supporting the importance of prompt diagnosis, referral, and treatment.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Table 1 Baseline characteristics

 

Table 2 Predictors Associated with Visual Acuity at 12 Months