Abstract
Purpose :
While cigarette smoking is a major modifiable risk factor for age-related macular degeneration (AMD), its impact on the response to anti-VEGF treatment is unclear. Here, we performed a retrospective, observational clinical study to determine the effect of smoking on OCT changes and visual acuity in response to anti-VEGF therapy for patients with exudative AMD.
Methods :
1745 eyes from 1409 patients with exudative AMD receiving anti-VEGF injections between 1/2015-12/2022 at the Wilmer Eye Institute were analyzed. Patients were categorized as Never- (NS), Former- (FS), and Current-smokers (CS), with pack-year data collected when available. Visual acuity (logMAR), number of injections, and OCT measures [central retinal thickness (CRT) and presence/change in intraretinal or subretinal fluid (IRF, SRF)] were obtained at baseline and after 1/6/12 months of anti-VEGF therapy.
Results :
Of the 1745 eyes, 774 were NS, 888 FS, and 83 CS. CS had a 21.04±17.04 pack-year history, while FS had 24.34±19.37 pack-years. Aflibercept was used in more NS/FS patients than CS compared to bevacizumab (66% vs 61% vs 34%, p<0.001). Baseline visual acuity and presence of IRF did not differ across groups, but CRT (326±148 (NS) vs 384±197 (FS) vs 377±156µm (CS), p<0.001) and SRF (79% (NS) vs 80% (FS) vs 67% (CS), p=0.022) did. The change in CRT at months 1/6/12 compared to baseline was smaller in CS than NS/FS. Decreases in IRF and SRF occurred in a larger proportion of NS and FS patients at all time points compared to CS patients. Number of injections were greater for NS/FS compared to CS at month 6 (4.77±1.33 (NS) and 4.54±1.23 (FS) vs 4.04±1.39 (CS), p<0.001) and 12 (7.52±2.48 (NS) and 7.57±2.49 (FS) vs 6.70±2.14 (CS)). Notably, visual acuity at month 6 worsened from baseline in CS while it improved in NS/FS (logMAR: +0.11±0.52 vs -0.04±0.41 and -0.08±0.35, p=0.0008 and p<0.0001, respectively), but was similar across groups at 12 months.
Conclusions :
Current-smokers with exudative AMD appear to have a slower response to anti-VEGF treatment compared to former- and never-smokers. Further study on the impact of smoking with anti-VEGF treatment for exudative AMD is warranted.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.