Outcomes of Patients With Exudative Age-Related Macular Degeneration Treated With Antivascular Endothelial Growth Factor Therapy for Three or More Years

Qin, Vivian L.; Young, Jason; Silva, Fabiana Q; Conti, Felipe F.; Singh, Rishi P.

doi:10.1097/iae.0000000000001753

Cited by 23 publications

(16 citation statements)

References 26 publications

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“…There has been much debate about whether retina specialists under-treat with anti-VEGF therapy in a real world setting, and whether undertreatment could account for the observed VA decline after 2 years of treatment in CATT and other studies 7,18,19 . There are undoubtedly some patients who do not receive sufficient anti-VEGF treatment, as evidenced by persistent VEGF-driven pathology such as intraretinal fluid that we observed at years 2 and year 5, and the slightly worse average VA (2.3 letters) seen at year 2 among eyes treated PRN when compared to those treated monthly.…”

Section: Discussionmentioning

confidence: 99%

Macular Morphology and Visual Acuity in Year Five of the Comparison of Age-related Macular Degeneration Treatments Trials

et al. 2019

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Associations between VA and morphologic features previously identified through year 1 were maintained or strengthened at year 5. New foveal scar, CNV, intraretinal fluid, SHRM and retinal thinning, development or worsening of foveal GA, and increased lesion size are important contributors to the VA decline from years 2 to 5. A significant need to develop therapies to address these adverse pathologic features remains.

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Section: Discussionmentioning

confidence: 99%

Macular Morphology and Visual Acuity in Year Five of the Comparison of Age-related Macular Degeneration Treatments Trials

et al. 2019

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“…Previous studies on long-term outcomes at 1,2 5 and 7 years have all shown the reduced effectiveness of anti-VEGF agents in clinical practice and most reports have attributed these results to the reduced number of injections over time [5,6,[10][11][12][13]. Qin et al in their study on long term outcomes of exudative AMD treatment have attributed the variable results to the differences in frequency and regularity of anti-VEGF treatment [14]. The extended CATT study and the VIEW 1 extension study concluded a direct association between the number of injections and final visual acuity with more number of injections resulting in better VA outcomes [15].…”

Section: Discussionmentioning

confidence: 99%

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Chandra

Arpa

Menon

et al. 2020

Eye

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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 mm 2 . 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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“… 122 , 126 – 128 Part of the reason for the loss of visual gains in the long-term is likely due to under-treatment in the “real” world. 129 , 130 However, as these retinas are virtually “dry” with little to no intraretinal fluid present, this suggests that something else is responsible for the decline in visual function observed in these patients. Even when the neovascular process is controlled, the underlying degenerative process continues with a progression of GA in patients with neovascular AMD.…”

Section: Neovascular Age-related Macular Degenerationmentioning

confidence: 99%

Advances in Age-related Macular Degeneration Understanding and Therapy

Miller¹,

Bagheri²,

Vavvas³

2017

US Ophthalmic Review

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While the development of anti-vascular endothelial growth factor (anti-VEGF) as a therapy for neovascular age-related macular degeneration (AMD) was a great success, the pathologic processes underlying dry AMD that eventually leads to photoreceptor dysfunction, death, and vision loss remain elusive to date, with a lack of effective therapies and increasing prevalence of the disease. There is an overwhelming need to improve the classification system of AMD, to increase our understanding of cell death mechanisms involved in both neovascular and non-neovascular AMD, and to develop better biomarkers and clinical endpoints to eventually be able to identify better therapeutic targets—especially early in the disease process. There is no doubt that it is a matter of time before progress will be made and better therapies will be developed for non-neovascular AMD.

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Outcomes of Patients With Exudative Age-Related Macular Degeneration Treated With Antivascular Endothelial Growth Factor Therapy for Three or More Years

Cited by 23 publications

References 26 publications

Macular Morphology and Visual Acuity in Year Five of the Comparison of Age-related Macular Degeneration Treatments Trials

Macular Morphology and Visual Acuity in Year Five of the Comparison of Age-related Macular Degeneration Treatments Trials

Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration

Advances in Age-related Macular Degeneration Understanding and Therapy

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