Macular Atrophy Incidence and Progression in Eyes with Neovascular Age-Related Macular Degeneration Treated with Vascular Endothelial Growth Factor Inhibitors Using a Treat-and-Extend or a Pro Re Nata Regimen

Abstract

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

“… 116 In a 4-year study, Spooner et al compared progression rates of macular atrophy among 264 eyes treated with anti-VEGF using either PRN or TREX regimes. 117 They found that VA gains among the TREX group were higher compared to the PRN group after 1 year of treatment (+2.7 vs +0.3 letters respectively), however these gains were lost after 4 years (+0.9 vs −0.5 letters, respectively). More long-term prospective data is needed between these two regimes.…”

Three-Year Outcomes of Neovascular Age-Related Macular Degeneration in Eyes That Do Not Develop Macular Atrophy or Subretinal Fibrosis

“…These cumulative rates of SRFi and MA were similar to those reported elsewhere. 9 , 16 , 17 The Macular atrophy in Pro re Nata versus Treat-and-Extend (MANEX) study reported that the incidence of new atrophy lesion in consecutive naïve treated nAMD eyes receiving VEGF inhibitors was approximately 19% and 22% at 2 and 3 years of treatment, respectively. 9 In the comparison of AMD Treatments Trials (CATT), non-geographic atrophy and scar rates were estimated to be approximately 12 to 19% and 16 to 20% at 2 years, respectively, depending on the type of drug and treatment pattern.…”

“… 9 , 16 , 17 The Macular atrophy in Pro re Nata versus Treat-and-Extend (MANEX) study reported that the incidence of new atrophy lesion in consecutive naïve treated nAMD eyes receiving VEGF inhibitors was approximately 19% and 22% at 2 and 3 years of treatment, respectively. 9 In the comparison of AMD Treatments Trials (CATT), non-geographic atrophy and scar rates were estimated to be approximately 12 to 19% and 16 to 20% at 2 years, respectively, depending on the type of drug and treatment pattern. 17 , 18 The FRB registry has implemented the ICHOM classification grading of SRFi and MA to standardize the diagnosis of these features and compare outcomes between different reports.…”

“… 6 – 8 Older age, presenting VA, and type of choroidal neovascularization (CNV) may predict risk of progression to MA and SRFi under treatment more strongly than treatment strategy and frequency. 1 , 9 , 10 Few studies, if any, have investigated whether there is any other mechanism that causes visual loss in eyes with nAMD independently of these features. Here, we tested the hypothesis that eyes with nAMD treated with VEGF inhibitors continue to lose vision through unknown mechanisms, even if they do not develop SRFi or MA.…”

Effectiveness of anti-vascular endothelial growth factors in neovascular age-related macular degeneration and variables associated with visual acuity outcomes: Results from the EAGLE study

“…The mean number of anti-VEGF injections in the EAGLE study at Year 1 was 5.6, an improvement on the previous routine clinical practice study, AURA (5.2 in 2 years for Italy) [ 15 ]. Despite this improvement, the mean number of injections clearly shows that patients in the EAGLE study were undertreated with respect to pivotal randomized controlled trials [ 10 – 12 , 16 ] and other routine clinical practice studies, particularly those adopting a proactive and customized treatment approach, with the goal of preventing disease recurrence [ 17 , 18 ].…”