Background Anti vascular endothelial growth factor (VEGF) therapy is an established treatment for various retinal diseases. Long-term data on injection frequencies and visual acuity (VA), however, are still rare.
Methods Five-year analysis of real-life VA developments and injection patterns from 2072 patients (2577 eyes; 33 187 injections) with chronically active disease undergoing pro-re-nata treatment for age-related macular degeneration (AMD), diabetic macular oedema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularisation (CNV).
Results Maximum mean VA gain in year 1 was+5.2 letters in AMD, +6.2 in DME, +10 in RVO and+7.2 in myopic CNV. Over 5 years, however, VA in patients with AMD declined. By year 5, 34% of patients with AMD had experienced VA loss of >15 letters, 56% had remained stable and 10% had gained >15 letters. Long-term VA developments in DME and RVO were more favourable with 81% of DME and 79% of patients with RVO gaining or maintaining vision at 5 years. In AMD, median injection frequency was six in year 1 and between four and five in consecutive years. In DME and RVO, median injection frequency was six in year 1 but lower compared with AMD in consecutive years. Injection frequency in DME was weakly associated with patient age (rs=0.1; p=0.03).
Conclusions In AMD, the initial VA gain was not maintained long term despite higher injection numbers compared with DME, RVO and myopic CNV. The presented real-world data provide a peer-group-based estimate of VA developments and injection frequencies for counselling patients undergoing long-term anti-VEGF therapy.
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Synopsis This study presents 5-year real-world data on visual acuity outcomes and intravitreal injection patterns from 2577 eyes treated for chronically active age-related macular degeneration, diabetic macular oedema, retinal vein occlusion and myopic choroidal neovascularisation.
Contributors TW and AS: study conception, data acquisition, analysis and interpretation of data, drafting and revising the manuscript, final approval and agreement to be accountable for all aspects of the work. CE: study conception, data acquisition, interpretation of data, revising the manuscript, final approval and agreement to be accountable for all aspects of the work. AB, CL and HA: data acquisition, interpretation of data, revising the manuscript, final approval and agreement to be accountable for all aspects of the work. DB: data analysis and interpretation of data, revising the manuscript, final approval and agreement to be accountable for all aspects of the work.
Funding AS is supported by the DFG (STA 1102/5-1) and the German Ophthalmic Society (DOG). This work was supported by a research grant from Novartis Germany.
Competing interests None declared.
Ethics approval Ethics committee at the University of Freiburg, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.
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