IRIS® Registry analysis of anti-VEGF treatment in patients with coexisting neovascular age-related macular degeneration and geographic atrophy

Abstract

Purpose : Geographic atrophy (GA) and neovascular age-related macular degeneration (nAMD) are features of advanced AMD and may manifest simultaneously. There is limited data on outcomes in eyes with combined GA and nAMD. This retrospective cohort study analyzed American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) data to characterize clinical features and anti-VEGF treatment outcomes in patients diagnosed with coexisting GA and nAMD.

Methods : Patients with ICD-10 codes for nAMD and GA in the same eye were identified in the IRIS registry between 7/1/2016 and 12/31/2021. Index date was defined as the first observed anti-VEGF injection. Anti-VEGF injection in the same eye within 36 months following GA diagnosis and at least one visual acuity (VA) measurement within 6 months prior to first injection were required. Eyes were divided into: Cohort 1; GA diagnosis following nAMD diagnosis, Cohort 2; GA diagnosis prior to nAMD diagnosis, and Cohort 3; coincident GA and nAMD diagnosis. GA treatment was not given in any eye. Demographics, clinical characteristics, anti-VEGF treatment patterns, VA and adverse events were assessed.

Results : Overall, 93,786 eyes with an ICD-10 code for both nAMD and GA were identified. Of these, 10,140 eyes of 8,324 patients, 12,509 eyes of 11,778 patients, and 4,189 eyes of 3,570 patients were included in Cohorts 1, 2, and 3, respectively. Across all cohorts, mean follow-up time was 2.4 years. Mean age was 81.4 years and 68% were female. Bevacizumab was the most utilized anti-VEGF agent at index across all cohorts. Mean anti-VEGF treatment intervals for Cohorts 1, 2, 3 were 8.09, 7.47, 8.27 weeks, respectively. Baseline VA was worse than 20/200 in 31.2%, 29.1% and 34.5% of patient eyes, respectively. After 6 years of follow-up, median VA dropped by -9, -5, and -9 ETDRS letters (Figure 1). Retinal vasculitis was observed in 0.02%, 0.06% and 0.02% of eyes and ischemic optic neuropathy in 0.2%, 0.3% and 0.2%, respectively over a mean follow-up period of 2.4, 2,3, and 2.9 years, respectively.

Conclusions : This study highlights the divergence in real-world outcomes of anti-VEGF treatment in patients with simultaneously diagnosed GA and nAMD from established clinical study and real-world findings in patients with nAMD alone.

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

 

Figure 1