Baseline Visual Acuity at Wet AMD Diagnosis Predicts Long-Term Vision Outcomes: An Analysis of the IRIS Registry

Abstract

BACKGROUND AND OBJECTIVE: Clinical trials in neovascular age-related macular degeneration (nAMD) demonstrate that high visual acuity (VA) can be maintained, and low VA can be improved with anti-vascular endothelial growth factor (VEGF) treatment. Few real-world data investigating the relationship between baseline VA and long-term outcomes exist. This study compares VA at diagnosis and after treatment using data from a large patient registry. PATIENTS AND METHODS: Retrospective study of IRIS Registry patients diagnosed with nAMD in one or both eyes between January 2013 and June 2017. Patients received at least two anti-VEGF injections in the study eye(s) less than 45 days apart during the study period. Primary outcomes were the percentage of eyes with 20/40 VA or better at diagnosis and association of VA at diagnosis with longer-term visual outcomes. RESULTS: The study included 162,902 eyes. Among all included eyes, 34.3% presented with 20/40 VA or better at diagnosis. Patients with 20/40 vision or better at baseline maintained a mean VA of 20/40 or better for 2 years after treatment initiation. CONCLUSIONS: Baseline VA at nAMD diagnosis predicts long-term VA outcomes. Early diagnosis before VA is adversely affected is a key factor in preserving vision in patients with nAMD. [ Ophthalmic Surg Lasers Imaging Retina . 2020;51:633–639.]

Predictors of Visual Acuity After Treatment of Neovascular Age-Related Macular Degeneration – Current Perspectives

“…27 While it appears that anti-VEGF treatment is more effective in eyes with poorer VA, patients presenting with better initial VA are more likely to have better final VA. A large retrospective analysis from the Moorfields Eye Hospital (MEH) database reported a 43% increase in likelihood for achieving and maintaining a VA of 20/40 for every 5-letter increase in VA at baseline. 28 Meanwhile, data from the Swedish Macular Register revealed that eyes with initial VA >60 letters (20/63) had only a 20% risk of having low VA (≤60 letters) after 1 or 2 years of treatment, compared to 60% in eyes with low initial VA. 29 This relationship has also been observed in several longterm studies, [30][31][32][33][34][35] suggesting that the larger visual gains in those with worse initial VA are not enough to overcome a good starting VA despite continuous treatment. As those with worse initial VA are also more likely to respond negatively to treatment, low baseline VA may be an indicator for worse disease severity as there may be underlying pathology not treatable by anti-VEGF, such as atrophy, scarring or other anatomical changes not controlled for in multivariate analysis.…”

Association Between Central Retinal Thickness and Visual Outcome Post Intravitreal Ranibizumab Injection Loading Doses in Exudative Age Related Macular Degeneration

“…For visual acuity better than 20/80 (LogMAR 0.6), 77.59% of the samples were found which is directly proportional to this study, which showed that visual acuity in patients with exudative AMD was still relatively good. 13 The MARINA and ANCHOR studies demonstrated that routine monthly injection of Ranibizumab increased mean best visual acuity (BCVA) by 20.5 and 21.5 letters, respectively, immediately after the third month of injection, as well as changes in OCT parameters in the HARBOR and PRONTO studies. Association between BCVA and CRT pre-Ranibizumab injection which showed a significance of 0.418 (>0.05), which means the data was not statistically significant, there was no relationship between BCVA and CRT pre-Ranibizumab injection, as well as the relationship between BCVA and CRT after Ranibizumab injection which showed a significance of 0.275.…”

Intravitreal Injection Therapy: Current Techniques and Supplemental Services

“…Earlier detection of conversion from dry AMD to wet AMD results in better visual outcomes. 63 Imaging. After retinal examination, additional testing and imaging may be needed for the injecting physician to decide if intravitreal injection is indicated.…”