Seven-Year Visual and Anatomical Outcomes of Intravitreal Vascular Endothelial Growth Factor Inhibition for Neovascular Age-Related Macular Degeneration

Abstract

Purpose. To evaluate 7-year visual and anatomical outcomes of intravitreal injections (IVI) with antivascular endothelial growth factor (anti-VEGF) for neovascular age-related macular degeneration (nAMD) based on a personalized pro re nata (PRN) regimen. Methods. Anonymized data of 124 consecutive eyes in 121 patients with treatment-naïve nAMD were initially collected in 2010. Of those, 45 received anti-VEGF IVI at least every 6months until 2017 in one single center in Austria and hence were retrospectively analyzed. All eyes had been initiated on a loading dose of 3 monthly IVI with different anti-VEGF agents followed by a PRN regimen in the first year. At year 2, monitoring as well as therapeutic intervention could be prolonged every 2weeks up to intervals of 3months without capping treatment. Primary outcome measure was the change of visual acuity (VA) assessed by Early Treatment Diabetic Retinopathy Study charts at 4 meters (ETDRS) in letters—counting every correctly read letter—and converted to Snellen. Secondary outcome measures were number of injections and change of central retinal thickness (CMT) from baseline. Results. Mean baseline VA was 20/63 + 1 (0.63 ± 0.26 ETDRS) and declined to 20/100 + 2 (0.45 ± 0.33) with an overall loss of 9 letters ETDRS after 7years (p = 0.001). An average of 3.5 ± 1.9 IVI was given per year and eye. Mean CMT at baseline was 322 ± 95 μm, decreased by 52 μm to 270 ± 70 μm within the first year, and remained below baseline at year 7 (271 ± 106 μm; p<0.001). Conclusions. Our data confirm an absolute vision loss in eyes compromised by nAMD after 7 years of continuous VEGF inhibition. The visual decline was significantly related to baseline VA as well as the number of injections. We suggest following patients thoroughly independent of the initial VA and a greater incentive for the physician to treat.

The Effect of Treatment Discontinuation During the COVID-19 Pandemic on Visual Acuity in Exudative Neovascular Age-Related Macular Degeneration: 1-Year Results

“…All patients routinely underwent a comprehensive ophthalmic examination including best-corrected VA using the Early Treatment Diabetic Retinopathy Study chart at 4 m (ETDRS)—counting every correctly read letter—converted to Snellen, indirect slit-lamp biomicroscopy (Haag-Streit AG, Bern, Switzerland) with dilated pupils using 0.5% tropicamide and spectral domain-optical coherence tomography (SD-OCT; Zeiss Cirrus HD 4000, Carl Zeiss Meditec AG, Jena, Germany) imaging at each follow-up. The decision for treatment and its respective interval was made after the loading dose of three monthly IVI [ 6 , 7 ]. Patients continued on a pro re nata regimen with individual visits and treatment as needed on the basis of the previously elaborated personal interval (see Fig.…”

Evaluation of a calculation model to estimate the impact of the COVID-19 pandemic lockdown on visual acuity in neovascular AMD

“…The decision for ongoing treatment and its respective interval was made after the loading dose of 3 monthly IVI. 8 , 9 Patients continued a pro-re-nata regimen with individual visits and treatment as needed based on the previously elaborated personal interval (supplementary material). Only patients with a VA of 40 letters ETDRS (20/160 Snellen) or better in the affected eye at last follow-up of the pre-lockdown era were enclosed in the study, who had an appointment within the time period of the first COVID-19 associated restrictions and who came back for a follow-up and treatment.…”