Characteristics of Eyes With Good Visual Acuity at 5 Years After Initiation of Treatment for Age-Related Macular Degeneration but Not Receiving Treatment From Years 3 to 5

Abstract

Identifying the characteristics of eyes with neovascular age-related macular degeneration (nAMD) that maintain good vision without anti-vascular endothelial growth factor treatment for at least 3 years after management, as occurred in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT), may have prognostic importance and help in understanding the disease and its treatment.OBJECTIVES To ascertain the characteristics of eyes in the CATT that retained good vision despite receiving no therapy for 3 years after release from the 2-year CATT treatment protocol. DESIGN, SETTING AND PARTICIPANTSThis case-control study analyzed the baseline and follow-up characteristics of eyes with nAMD that were enrolled in the CATT from 43 US clinical centers between February 20, 2008, and December 9, 2009. After initial randomization to 1 of 4 treatment groups (ranibizumab monthly, bevacizumab monthly, ranibizumab as needed, or bevacizumab as needed), at year 1, participants in the monthly groups were rerandomized to continue monthly treatment or to switch to as-needed treatment using the same drug as originally assigned. At year 2, participants were released from the protocol to treatment at the discretion of their ophthalmologist. At year 5, participants were recalled for examination. This present analysis, conducted from December 1, 2018, to September 30, 2019, compared the eyes of 40 participants (referred to as the cessation of treatment with good visual acuity, or CTGVA, group) with the eyes of the remainder of the CATT Follow-up Study (referred to as the other group). MAIN OUTCOMES AND MEASURESVisual acuity, morphologic characteristics, and number of treatments over 5 years. RESULTS Among 625 eyes with nAMD at baseline and a visual acuity measurement at year 5, 40 (6.4%; 95% CI, 4.7%-8.7%) were included in the analysis. These 40 participants, compared with the other group (n = 585), had a lower mean (SD) age of 74.7 (7.3) years (vs 77.7 [7.3] years; P = .01) and included 26 women (65.0%). Baseline characteristics were similar between eyes in the CTGVA and other groups, except for better visual acuity letter score in the study eye (68.8 vs 61.8; P = .001) and the fellow eye (78.4 vs 68.0; P = .01) as well as the presence of blocked fluorescence seen more often in participants in the CTGVA vs the other group (27.5% vs 13.8%; P = .02). Eyes in the CTGVA group with as-needed treatment received fewer mean (SD) injections in year 1 (5.8 [4.0] vs 8.1 [3.5]) and year 2 (7.7 [5.7] vs 13.8 [6.8]) than eyes in the other as-needed group. Mean (SD) visual acuity letter score at 5 years was 79.0 (5.5; Snellen 20/25) in the CTGVA group and 57.5 (24.2; Snellen 20/80) in the other group. CONCLUSIONS AND RELEVANCEThese findings suggest that a small proportion of eyes with nAMD can retain good visual acuity with no treatment for at least 3 years after the initial 2 years of treatment. Unique characteristics of eyes that could discontinue treatment while maintaining good visual acuity could not be identified at baseline, bu...

Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab

“…The authors concluded that continuing injections in these patients would result in overtreatment, as up 70% of patients were able to achieve a dry macula after 1 year of treatment, with greater than 55% of these patients remaining disease free at the 2-year mark. These results are consistent with a post-hoc analysis of the CATT trial which noted that a subset of patients can maintain good visual acuity despite holding treatment for 3 years after an initial treatment period (35).…”

“…Statistical analysis was performed using Chi-square and Mann-Whitney test. Data in bold are statistically significant.Cao et al,35…”

The Effect of Endophthalmitis on Recurrence of Macular Edema in Eyes Receiving Intravitreal Anti–vascular Endothelial Growth Factor

“…24 In a post hoc analysis of the CATT trial, 40 eyes required no further injections three years after trial completion. 25 These findings demonstrate that the natural course of nAMD may require fewer injections over time.…”

Single Injection Response to Antivascular Endothelial Growth Factor Agents in Patients With Wet Age-Related Macular Degeneration

“…Fluid compartments, as well as associated clinical findings such as hemorrhage or fibrosis were defined in accordance with the recently published consensus guidelines. 14 The intent of our study was based on similar grounds 28 : documentation of complete fluid resolution with a single injection (patients in this post hoc analysis required more injections). There seems to be a rising consensus that IRF, especially recurrent IRF is associated with poorer final visual outcomes.…”

“…The intent of our study was based on similar grounds 28 : documentation of complete fluid resolution with a single injection (patients in this post hoc analysis required more injections). There seems to be a rising consensus that IRF, especially recurrent IRF is associated with poorer final visual outcomes.…”