Background To assess the prevalence and characteristics associated with macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors.
Methods This was a retrospective, cross-sectional study of nAMD eyes that commenced anti-VEGF between January 2006 and August 2016. MA (absent/extrafoveal/subfoveal) was graded by treating practitioners based on multimodal imaging from April 2016. The prevalence of MA over time and risk factors of MA were assessed.
Results The prevalence of MA in a cohort of 1689 eyes was 9.9% (22/222) in eyes within 1 year of starting treatment, 41.5% (71/171) after 5 years and 48.4% (30/62) after 9 years of treatment. Risk factors for subfoveal MA included the proportion of visits at which the lesion was graded as inactive ((adjusted OR (AOR) 3.72 for the highest vs lowest the quartile of frequency of inactive gradings (95% CI 2.33 to 6.07)), age (AOR 1.05 per year (95% CI 1.02 to 1.07)), baseline visual acuity (AOR 3.9 for ≤35 letters vs ≥70 letters (95% CI 2.4 to 6.4)) and the number of injections received (AOR 1.20 every 10 injections (95% CI 1.08 to 1.33)). Similar associations were observed with extrafoveal MA.
Conclusions The risk of MA appeared to drop in eyes that had not developed it within 5 years. Low choroidal neovascularisation activity was by far the strongest predictor. We could not determine whether the increased prevalence of MA with time was due to anti-VEGF treatment or the natural history of the condition.
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Collaborators D Squirrell; A Cohn; I McLean; A Field; C Dayajeewa; A Dunlop; C Ng; S Young; L Chow; A Amini; G Clark; P Windle; A Hunt; J Chen; J Landers; K Billing; M Perks; N Saha; S Lake; S Lal; L Manning; H Cass; A Thompson; J Game; C Thompson; S Fraser-Bell; A Fung; C Younan; R Barnes; A Vincent; N Murray; B Swamy; P Hinchcliffe; M Daniell; A Harper; J O’Day.
Contributors VD, VN, MCG and DB were involved in the conception and design of the study. RWE, RG, JJA, MCG and DB were involved in the data collection. VD, VN, RWE, RG, JJA, MM, LC, MCG and DB were involved in the analysis and interpretation of the data. VD wrote the first draft of the manuscript. All authors were involved in the critical revision and final approval of the article. VD, VN, MCG and DB were involved in the conception and design of the study. RWE, RG, JJA, MCG and DB were involved in the data collection. VD, VN, RWE, RG, JJA, MM, LC, MCG and DB were involved in the analysis and Interpretation of the data. VD wrote the first draft of the manuscript. All authors were involved in the critical revision and final approval of the article.
Funding Supported by a grant from the Royal Australian NZ College of Ophthalmologists Eye Foundation (2007-2009), a grant from the National Health and Medical Research Council, Australia (NHMRC 2010-2012) and a grant from the Macular Disease Foundation, Australia. MCG is a Sydney Medical Foundation Fellow and is supported by an NHMRC practitioner fellowship. DB was supported by the Walter and Gertud Siegenthaler Foundation Zurich, Switzerland and the Swiss National Foundation. Funding was also provided by Novartis and Bayer.
Disclaimer Supporting organisations had no role in the design or conduct of the research.
Competing interests MCG and DB are inventors of the software used to collect the data for this analysis. MCG and JJA are members of advisory boards for Novartis, Bayer and Allergan. JJA reports personal fees and other from Novartis, other from Bayer, outside the submitted work.
Patient consent for publication Not required.
Ethics approval Institutional ethics approval was obtained from the South Eastern Sydney Local Health District Human Resarch Ethics Committee, Royal Australian and New Zealand College of Ophthalmologists and the Cantonal Ethics Committee Zurich, Switzerland.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.