Characterization of Poor Visual Outcomes of Neovascular Age-related Macular Degeneration Treated with Anti–Vascular Endothelial Growth Factor Agents

Nguyen, Chu Luan; Gillies, Mark C; Nguyen, Vuong; Daïen, Vincent; Cohn, Amy C; Banerjee, Gayatri; Arnold, Jennifer

doi:10.1016/j.ophtha.2018.11.036

Cited by 29 publications

(27 citation statements)

References 20 publications

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“…That is consistent with a former study (Brown et al 2013). In the SMR, the diameter of the lesion size was measured in lm as in another database, the international Fight Retinal Blindness registry, (Nguyen et al 2019). The overall median baseline lesion size of 2235 lm (1300-3340) (Q1-Q3) in our study was almost identical compared to a study from the FRB with an overall median baseline lesion size of 2250 lm (1439-3200).…”

Section: Discussionsupporting

confidence: 90%

“…When analysing risk factors for a less favourable outcome we found, in agreement with previous studies, that eyes of patients with a final VA of ≤ 35 letters were older than patients with a final VA of > 35 letters (Nguyen et al 2019). Despite our expectations, we did not see a difference in symptom duration before the first clinical visit between the group with a final VA of > 35 letters and the one with a final VA of ≤ 35 letters.…”

Section: Discussionsupporting

confidence: 89%

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Twelve per cent of 6142 eyes treated for neovascular age‐related macular degeneration (nAMD) presented with low visual outcome within 2 years. Analysis from the Swedish Macula Registry (SMR)

Schroeder

Westborg

Adrian

2019

Acta Ophthalmologica

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Purpose: To analyse characteristics from the SMR to explore the risk factors for visual acuity (VA) below ≤ 35 letters of the Early Treatment Diabetic Retinopathy Study (ETDRS) due to nAMD during a two-year follow-up. Methods: This study evaluates 6142 treatment-na€ ıve eyes, with focus on a subgroup of 780 eyes with final VA outcome of ≤ 35 letters, regarding differences of baseline characteristics, change of VA, number of injections and choice of drug to predict visual outcome. Results: Patients with final VA ≤ 35 letters were older; p < 0.0001, and received fewer injections, 6.2 AE 3.8 vs. 8.7 AE 5.4; p < 0.00001. Only 4% of all patients with ≥ 70 letters baseline VA decreased to a final VA of ≤ 35 letters. The two groups with a final VA of ≤ 35 letters and VA > 35 letters presented the following baseline lesion locations; p = 0.001; 61% vs. 57% subfoveal, 18% vs. 21% juxtafoveal and 4% vs. 6% extrafoveal. Lesion size, in the group with final VA ≤ 35 letters, was 2805 AE 2093 lm vs. 2440 AE 1637 lm in the group with a VA of > 35 letters; p = 0.005. A logistic regression analysis including baseline VA, best-or worseseeing eye, age, membrane size, membrane location, symptom duration showed VA; p = < 0.0001, best-or worse-seeing eye; p = 0.026, age; p = < 0.0001, and membrane size; p = 0.002 to predict a decline of VA within 2 years. Conclusions: In eyes treated for wet AMD and studied for 2 years, 12.7% of eyes declined to a final VA of ≤ 35 letters. Visual acuity, worse-seeing eye treated, age and membrane size turned out as the baseline characteristics that had significantly influenced visual decline to ≤ 35 letters during the two-year follow-up.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Twelve per cent of 6142 eyes treated for neovascular age‐related macular degeneration (nAMD) presented with low visual outcome within 2 years. Analysis from the Swedish Macula Registry (SMR)

Schroeder

Westborg

Adrian

2019

Acta Ophthalmologica

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“… 1 , 2 However, the completeness of data has been a potential source of bias since the majority of trials and real world studies have reported data from less than 50% of their original cohorts. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 13 …”

Section: Discussionmentioning

confidence: 99%

“… 4 , 5 , 6 , 7 The multivariable analysis also revealed a strong interaction between age and time: DVA declined faster in older participants. Several studies 13 , 15 have identified increasing age as an adverse predictor of visual outcome but have merely reported findings for dichotomized age groups, for example, comparing those aged 80 years and above with those younger than 80 years of age. Our finding is of high clinical relevance both for counseling and in the management of patients, acknowledging that age is likely a proxy for complex underlying comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Long-term Visual Outcomes after Release from Protocol in Patients who Participated in the Inhibition of VEGF in Age-related Choroidal Neovascularisation (IVAN) Trial

et al. 2020

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Purpose To describe visual outcomes, frequency of treatment and monitoring visits, and anti–vascular endothelial growth factor drugs used in usual care in participants who exited a trial in which treatment for neovascular age-related macular degeneration (nAMD) was initiated with bevacizumab or ranibizumab. Design Multicenter cohort study up to 7 years after trial exit. Participants Patients enrolled in the Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial; after excluding participants from 2 sites and who died or withdrew during the trial, 537 were included in this follow-up cohort. Methods Data were collected between May 26, 2016, and August 24, 2017. Distance visual acuity (DVA) (letters read) in both eyes and treatments for nAMD administered to either eye at all usual care visits were extracted from medical records of all participants until the point of data collection (duration of study eye monitoring). Main Outcome Measures Rate of change of DVA during active surveillance of the study eye (study eye monitoring), estimated using a multivariable linear random effects model. Other outcome measures were visit and treatment frequency and switches in anti–vascular endothelial growth factor (VEGF) drug. Results Data were obtained for 99% (532/537) of eligible participants. The median duration of study eye monitoring after IVAN exit was 3.3 years (interquartile range [IQR], 1.3–4.7), and median DVA was 58.0 letters (IQR, 34.0–73.0). Study eye DVA deteriorated by 4.3 (95% confidence interval [CI], 3.7–4.9) letters per year. Injection rate did not influence the rate of change in DVA after adjusting for key covariates. After IVAN exit, 174 participants (32%) received no treatment; 332 of 358 (93%) were treated first with ranibizumab, 78 (23%) of whom switched to aflibercept. The DVA was similar among participants who switched or did not switch at the end of study monitoring. Conclusions Approximately 5 years after the IVAN study finished, with unprecedented completeness of follow-up for such a trial, the trajectory of functional decline in the study eye was shown to be greater than that previously reported for incomplete trial cohorts. Anti-VEGF injection rates and treatment switches were not important factors in determining visual acuity outcomes.

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“…We thank our colleagues for their comments on our paper. 1 Dr Kim was particularly interested in whether eyes with retinal angiomatous proliferation (RAP) had different outcomes in real-world practice. Unfortunately, this article cannot answer that question because RAPs were included in a group of other less commonly diagnosed conditions such as polypoidal choroidal vasculopathy, which probably have different outcomes.…”

Section: Replymentioning

confidence: 99%

Re: Nguyen et al.: Characterization of poor visual outcomes of neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents (Ophthalmology. 2019;126:735-742)

Kim

2020

Ophthalmology

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TO THE EDITOR: I read the article by Nguyen et al 1 reporting the baseline predictors of poor visual outcomes in eyes with neovascular age-related macular degeneration (nAMD). Although previous studies have investigated similar topics, this study provides valuable additional information because the analyses were performed using a large dataset from daily clinical practice. In this study, age >80 years, fewer injections, and more visits at which choroidal neovascularization was graded as active were found to be associated with a higher incidence of sustained visual loss. However, baseline angiographic lesion criteria were not a significant factor. In the angiographic lesion criteria (Tables 1, 3, and 4 in the original article), I noticed that retinal angiomatous proliferation (RAP) was categorized as "other," together with conditions such as idiopathic polypoidal choroidal vasculopathy. RAP, also referred to as type 3 neovascularization, is a distinct subtype of nAMD that is characterized by intraretinal neovascularization. 2 There is a difference in clinical course between RAP and typical nAMD, as there are differences in characteristics. Although antievascular endothelial growth factor treatment is effective in RAP, we occasionally encounter patients with a poor prognosis in daily clinical practice. The reasons for this poor prognosis can be geographic atrophy, tearing of the retinal pigment epithelium, or development of submacular hemorrhage/recurrent hemorrhage. 3-5 For this reason, I believe that if RAP were analyzed separately as an independent factor, the association of angiographic lesion criteria with sustained visual loss may be slightly different. In this respect, if the author can present additional data or analysis results, it will be of great help to clinicians treating RAP. If additional reporting is difficult, I would really appreciate that the authors become aware of this point of view and try and incorporate it in future research.

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Characterization of Poor Visual Outcomes of Neovascular Age-related Macular Degeneration Treated with Anti–Vascular Endothelial Growth Factor Agents

Cited by 29 publications

References 20 publications

Twelve per cent of 6142 eyes treated for neovascular age‐related macular degeneration (nAMD) presented with low visual outcome within 2 years. Analysis from the Swedish Macula Registry (SMR)

Twelve per cent of 6142 eyes treated for neovascular age‐related macular degeneration (nAMD) presented with low visual outcome within 2 years. Analysis from the Swedish Macula Registry (SMR)

Long-term Visual Outcomes after Release from Protocol in Patients who Participated in the Inhibition of VEGF in Age-related Choroidal Neovascularisation (IVAN) Trial

Re: Nguyen et al.: Characterization of poor visual outcomes of neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents (Ophthalmology. 2019;126:735-742)

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