Neovascular Age-Related Macular Degeneration in the Very Old (≥90 Years): Epidemiology, Adherence to Treatment, and Comparison of Efficacy

Abstract

Purpose To investigate neovascular age-related macular degeneration (AMD) in patients aged ≥90 years from several perspectives for a comprehensive overview: prevalence, presenting characteristics, treatment adherence, reasons for discontinuation, and efficacy of antivascular endothelial growth factor (VEGF) treatment comparing Ranibizumab and Aflibercept. Methods In this retrospective chart review, we determined the prevalence and presenting characteristics by reviewing all data for patients referred to our department with treatment-naïve neovascular AMD. By looking at historical cohorts, we determined adherence to treatment, reasons for discontinuation, and treatment outcomes after loading dose, 12 months, and 24 months. Results Patients aged ≥90 years constituted 7% of the patients. Treatment was discontinued in 51%, primarily because of death and treatment burden. Mean change in best-corrected visual acuity was 3.2, 1.5, and −2.2 ETDRS letters at 4, 12, and 24 months, respectively. Aflibercept was superior to Ranibizumab in visual and anatomic outcomes. After two years of treatment, patients losing ≥15 ETDRS letters made up 19% in the Aflibercept group and 26% in the Ranibizumab group. Conclusions We propose that the very old patients with neovascular AMD may constitute a distinctive group warranting special attention and possibilities for individualized therapy. Possible differences between anti-VEGF agents need further investigations.

CD11b and CD200 on Circulating Monocytes Differentiate Two Angiographic Subtypes of Polypoidal Choroidal Vasculopathy

“…1 The late stage of the disease includes an exudative phenotype where proliferating choroidal vessels break through the Bruch's membrane resulting in hemorrhage and exudate in the macula, which impairs visual acuity and function. [2][3][4] Although the etiology of neovascular AMD is not fully understood, growing evidence suggest a key role for chronic neuroinflammation and microglial activity (resident macrophages of the retina) that result in a proinflammatory environment wherein VEGF secretion is a drive-force for the choroidal neovascularizations (CNV). [5][6][7] An important differential diagnosis to neovascular AMD is polypoidal choroidal vasculopathy (PCV).…”

Three-Year Outcomes of Patients with Neovascular Age-Related Macular Degeneration Treated with Aflibercept under the National Health Insurance Program in Taiwan

“…e mean age of our patients (around 83 years) was older than in other real-world nAMD studies (<80 years) [18][19][20][21][22]. Although age played a minor role in the final VA, other studies have reported that older age may be related to a poor visual outcome [23,24]. e baseline VA (0.78 logMAR) in our study was inferior than in other real-world studies (around 60 EDTRS letters, equal to 0.5 logMAR) [18][19][20][21][22].…”

Intravitreal Injections with Vascular Endothelial Growth Factor Inhibitors: A Practical Approach

“…Compensation rates for IVIs can vary by almost a factor of ten across Europe [13]. In Germany and Denmark, IVIs are restricted to large public hospitals [13], which impacts the perceived burden of treatment on patients from rural areas [16]. There are also differences in whether there are organizational incentives to increase or decrease the number of IVIs (which can be obtained through different treatment regimens) or the waiting times for patients [13].…”