Abstract
Purpose :
Neovascular age-related macular degeneration (nAMD) can present with severe central vision loss. However, a subset of patients with image-confirmed nAMD have unaffected best-corrected visual acuity (BCVA). Clinical trials in nAMD often exclude eyes with baseline vision >20/40, leaving a gap in the literature on their characteristics, treatment outcomes, and optical coherence tomography (OCT) findings. This study aimed to characterize the outcomes of 5-year anti-vascular endothelial growth factor (VEGF) monotherapy in patients who presented with good vision (>20/40) and nAMD.
Methods :
Retrospective review of patients with naive nAMD and >20/40 BCVA diagnosed between 2011-2018. Eyes with a history of anti-VEGF injections, less than 5-year follow-up, and history of vitrectomy or ocular diseases were excluded. Data was collected over 5 years for BCVA, anti-VEGF frequency, and treatment free intervals. OCT images were analyzed at baseline and every 6 months, with collection of choroidal neovascular (CNV) length, central macular thickness (CMT), and subfoveal choroidal thickness (SCT). Summary statistics were reported as mean and standard deviation. Parameters were compared using chi-squared, Kruskal-Wallis, and paired t-tests. P-value ≤ 0.05 was considered significant.
Results :
At year 1, inclusion criteria were met by 89 eyes, followed by 70 eyes at year 2, 57 at year 3, 51 at year 4, and 48 at year 5. For this study, 48 eyes from 44 patients were analyzed. Mean age at presentation was 73 ± 8.7 with 17 (39%) male and 27 (61%) female eyes. Mean baseline logMAR VA was 0.12 ± 0.06 (20/26 Snellen VA) and 0.27 ± 0.39 (20/37) at year 5 (p < 0.05). Over 5 years, mean injection per eye was 22.3 ± 13.6 with mean treatment-free interval of 7.6 ± 3.9 months. 32 (65%) eyes maintained >20/40 VA at year 5. Analysis of OCT markers indicated no significant difference in SCT and CNV length from baseline to year 5. CMT decreased from 271.4 ± 45.7 to 241.8 ± 34.6 (p<0.01) following 5-year as-needed monotherapy. Among eyes with worsened VA, double layer sign length increased from 1140.7 ± 597.0 to 1955.3 ± 1323.2 (p = 0.01). Most common causes for decline in VA included subretinal hemorrhage, pigment epithelial tear, and progressive atrophy.
Conclusions :
The majority of patients who presented with good vision and nAMD maintained >20/40 BCVA following 5-year as-needed anti-VEGF monotherapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.