Smoking Status and Treatment Outcomes of Vascular Endothelial Growth Factor Inhibitors for Neovascular Age-Related Macular Degeneration

Abstract

PURPOSE To assess whether smoking status affects 1-year visual outcomes in eyes treated with vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration. METH-ODS Retrospective analysis of data from a prospectively designed, multicenter, observational database. Nine hundred and eighty seven treatment-naive eyes of patients with neovascular age-related macular degeneration were tracked by the Fight Retinal Blindness! outcome registry in Australia, New Zealand, Singapore, and Switzerland who had documented smoking status at baseline and commenced vascular endothelial growth factor inhibitor therapy from January 2006 to December 2016. Generalized additive models were used to display visual acuity results. RESULTS There was a significant difference in mean improvement in visual acuity at 12 months between nonsmokers, ex-smokers, and current smokers (7.7 vs. 6.1 vs. 3.5 letters of change; P = 0.046) among patients who completed 12 months of treatment when adjusted for age, baseline visual acuity, and choroidal neovascular membrane lesion type and nested for practice. There was no significant difference in the median number of injections over 12 months of treatment by smoking status. Current smokers were a mean of 6.2 years younger than nonsmokers when they started treatment (P < 0.001). CONCLUSION This study found inferior 12-month visual outcomes in patients who continued to smoke while receiving vascular endothelial growth factor inhibitor therapy for neovascular age-related macular degeneration.

Smoking Is a Risk Factor for Pahcychoroid-related Disorders in Asian Patients: a Case Control Study

“…However, the ve-year outcomes in the CATT study reported that cigarette smoking was associated with an increased risk of poor visual prognosis (20/200 or worse) [51]. In a prospective study examining 987 eyes, nonsmokers had higher visual acuity improvements than former and current smokers [52]. In contrast, McKibbin et al demonstrated that the visual outcome associated with anti-VEGF therapy for nAMD was not signi cantly different among never smokers, former smokers, and current smokers [53].…”

Neovascular age‐related macular degeneration: A review of findings from the real‐world Fight Retinal Blindness! registry

“…analysis that separately analysed smoking status as a potential risk factor for poor outcomes found it was associated with a lower adjusted mean (95% CI) VA change at 12 months (+4.6 [1.5, 7.8] letters) compared with ex‐smokers (+5.9 [3.4, 8.3] letters) and non‐smokers (+8.0 [6.0, 10.0] letters). 65 …”

“…analysis that separately analysed smoking status as a potential risk factor for poor outcomes found it was associated with a lower adjusted mean (95% CI) VA change at 12 months (+4.6 [1.5, 7.8] letters) compared with ex-smokers (+5.9 [3.4, 8.3] letters) and non-smokers (+8.0 [6.0, 10.0] letters). 65 Although macular atrophy and subretinal fibrosis are the most common causes of poor long-term outcomes for nAMD patients, adverse ocular events specifically associated with anti-VEGF therapy are quite rare. 8,66 The rarity of these events makes real-world data more suited to monitoring their rate and subsequent than RCTs.…”

What did we learn in 35 years of research on nutrition and supplements for age‐related macular degeneration: a systematic review

“…As AMD still is an incurable eye disease, strategies for primary and secondary prevention are of paramount importance. For example, smoking cessation can have a significant impact on the patients' prognosis and treatment response, even at an older age (Vittorio et al 2020). In addition, nonpharmacological interventions by way of nutrition and supplements have been investigated.…”