Abstract
Purpose
Single center, noninterventional cohort study to assess 10-year visual and anatomical outcomes following initiation of treatment with antivascular endothelial growth factor (anti-VEGF) agents in neovascular age-related macular degeneration (AMD) patients. Neovascular AMD patients initiated on intravitreal anti-VEGF injections in 2008–2009 and continued to be followed up for at least 10 years were included in this study.
Methods
The Moorfields OpenEyes database was searched for all patients who were initiated on anti-VEGF therapy for neovascular AMD in 2008–2009 and the visual acuity (VA) in Early Diabetic Retinopathy Study (ETDRS) letters and injection records were analyzed for those who have had at least 10-year follow-up. The spectral-domain optical coherence tomography (SD-OCT) scans, color fundus photos, and fundus fluorescein angiography (FA) were graded by two retinal physicians. The outcomes were also compared between those with good and poor VA outcomes based on pre-defined criteria. The primary end point was change in VA at 10 years; secondary outcomes included percentage with VA of 20/40 or better, 20/70 or better, VA gains and losses, anatomic outcomes and number of injections.
Results
After a mean of 10.04 years after initiation of anti-VEGF therapy, the mean decline in VA from baseline was −2.1 ETDRS letters (SD 19.9, p = 0.65). One hundred eyes (67.1%) achieved a VA threshold of 20/70 or better, 33.5% achieved a VA of 20/40 or better, and 76.5% eyes maintained VA defined as a loss of less than 15 letters. Fourteen percent of study eyes had VA of 20/200 or worse and 23.5% declined by 15 letters or more. 87.5% of eyes were switched from ranibizumab to aflibercept during the course of 10 years and the eyes received a mean of 52.2 (SD 18.1) injections over 10 years. From this cohort, 87 (58.3%) eyes are having on-going treatment. On OCT, 34.9% had persistent fluid at the last visit, 6.7% patients showed new onset atrophy compared to baseline, and 43.7% had increased area of macular atrophy. The mean area of atrophy at the final visit was 4.15 mm2. Comparison between the good and worse visual outcome groups showed lower baseline VA, fovea-involving atrophy and final area of atrophy had a statistically significant negative effect on the final visual outcome (p < 0.05).
Conclusions
Regular monitoring and anti-VEGF treatment over 10 years reduce the risk of visual loss of 15 letters or more in patients with neovascular AMD. The most common cause of substantial visual decline was macular atrophy.
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Acknowledgements
We would like to thank the Moorfields Medical Retina Group for their contribution and collation of patients. The research was supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.
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SS reported receiving research grants from Novartis, Bayer, Allergan, Roche, Boehringer Ingelheim, and Optos Plc, travel grants from Novartis and Bayer, speaker fees from Novartis, Bayer, and Optos Plc, and attending advisory board meetings for Novartis, Bayer, Allergan, Roche, Boehringer Ingelheim, Optos Plc, and Heidelberg Engineering. PH reported receiving research grants from Novartis Allergan and Bayer, travel grants from Novartis Allergan and Bayer, speaker fees from Novartis Allergan and Bayer, and attending advisory board meetings for Novartis, Bayer, and Allergan. LN reported receiving speaker fees from Allergan. RH reports personal fees from Bayer, Novartis, Allergan and Ellex. PAK has received speaker fees from Heidelberg Engineering, Topcon, Carl Zeiss, Meditec, Haag-Streit, Allergan, Novartis and Bayer. He has served on advisory boards for Novartis and Bayer and has been external consultant for DeepMind and Optos. He is supported by a UK National Institute for Health Research (NIHR) Clinician Scientist Award (NIHR-CS—2014-12-23). SC, CA, DM, HK, and BP have no disclosures.
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Chandra, S., Arpa, C., Menon, D. et al. Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration. Eye 34, 1888–1896 (2020). https://doi.org/10.1038/s41433-020-0764-9
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DOI: https://doi.org/10.1038/s41433-020-0764-9
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