Long-Term Outcomes and Incidence of Recurrence of Neovascularization in Treated Exudative Age-Related Macular Degeneration

Haddad, W.M.; Minous, Florence Le; Legeai, J.; Souied, Eric H.

doi:10.1097/iae.0000000000001282

Cited by 23 publications

(25 citation statements)

References 37 publications

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“…This was one of the few PRN studies that demonstrated an average final vision above baseline, although this was still not statistically significant [37]. Others, such as those by Gillies et al [38], Zhu et al [39], Haddad et al [40], the PACORES study group [41] and Westborg et al [42] recorded average visual losses from as little as −4.3 letters to as much as −25.4 letters from peak visual gains, when studied over the long term.…”

Section: Pro-re-nata (Prn) Dosingmentioning

confidence: 87%

“…Although there is no long-term head-to-head comparison study between TAE/TES vs. PRN treatment methods in RCTs or private practice, a comparison of these outcomes individually reveals that the TAE/TES method is superior. RCTs, such as the CATT-5 and SEVEN-UP studies, along with many retrospective studies employing the PRN method beyond an average follow-up time of 3 years (up to 7 years) have demonstrated average visual changes of +1.4 to −19.3 letters from baseline vision [35][36][37][38][39][40][41][42]. Conversely, prospective and retrospective data have reported visual increases of 5-9.7 letters for similar time intervals in eyes managed by a TAE/TES strategy [43,49,50].…”

Section: Treat-and-extend (Tae) and Treat-extend-stop (Tes) Methodsmentioning

confidence: 99%

“…Many studies have described recurrence as any new onset of fluid or exudation regardless of time, thus implicitly suggesting that active disease is controlled as soon as the macula is deemed "dry". Other studies use the term "disease recurrence" to mean new onset CNV or exudation after disease remission, for example, a minimum time criterion of 4 months with no evidence of fluid or exudation ("active disease") [40,43]. At present, there is no formal definition accepted.…”

Section: Dosing Strategy and Effect On Disease Activity Recurrence Amentioning

confidence: 99%

“…Two retrospective studies have reported this phenomenon. In the first, Haddad et al utilized a PRN dosing method in 132 eyes over an average follow-up of 7.75 years [40]. Eighty-three (63%) eyes experienced long-term remission without requiring treatment for 1 year at least one time during the duration of the study [40].…”

Section: Dosing Strategy and Effect On Disease Activity Recurrence Amentioning

confidence: 99%

“…In the first, Haddad et al utilized a PRN dosing method in 132 eyes over an average follow-up of 7.75 years [40]. Eighty-three (63%) eyes experienced long-term remission without requiring treatment for 1 year at least one time during the duration of the study [40]. However, among them, 42 (51%) eyes experienced a true recurrence of CNV [40].…”

Section: Dosing Strategy and Effect On Disease Activity Recurrence Amentioning

confidence: 99%

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Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

Chaili¹,

Adrean²

2020

Visual Impairment and Blindness - What We Know and What We Have to Know

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The purpose of this chapter is to examine the various treatment strategies used to manage neovascular age-related macular degeneration (nAMD). The chapter will focus on the three main strategies including fixed interval dosing, as needed Pro-Re-Nata (PRN) treatment and Treat-and-Extend (TAE), with its variant the Treat-Extend-Stop (TES) protocol. We will discuss the visual results of randomized clinical trials and retrospective studies using these methodologies and compare their outcomes, the pros and cons of each treatment strategy, as well as the underlying mechanisms that may explain these differences. The results of long-term extension trials following landmark randomized clinical studies and other long-term retrospective studies will also be compared to studies using a fixed interval dosing or the TAE/ TES method. We will also focus on the visual results of the TES protocol and examine recurrence rates, proposing a definition of the recurrence of choroidal neovascularization (CNV) versus increased disease activity. These topics discussed will help optimize anti-VEGF treatment regimens for patients with nAMD over the long term.

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Section: Pro-re-nata (Prn) Dosingmentioning

confidence: 87%

Section: Treat-and-extend (Tae) and Treat-extend-stop (Tes) Methodsmentioning

confidence: 99%

Section: Dosing Strategy and Effect On Disease Activity Recurrence Amentioning

confidence: 99%

Section: Dosing Strategy and Effect On Disease Activity Recurrence Amentioning

confidence: 99%

Section: Dosing Strategy and Effect On Disease Activity Recurrence Amentioning

confidence: 99%

See 3 more Smart Citations

Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

Chaili¹,

Adrean²

2020

Visual Impairment and Blindness - What We Know and What We Have to Know

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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

et al. 2020

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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...

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Long-term outcomes of polypoidal choroidal vasculopathy in comparison with typical exudative age-related macular degeneration

Roh

Kim

Kang

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Long-Term Outcomes and Incidence of Recurrence of Neovascularization in Treated Exudative Age-Related Macular Degeneration

Cited by 23 publications

References 37 publications

Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

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

Long-term outcomes of polypoidal choroidal vasculopathy in comparison with typical exudative age-related macular degeneration

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