Background To describe 10-year trends in visual outcomes, anatomical outcomes and treatment burden of patients receiving antivascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD).
Methods Retrospective cohort study of treatment-naïve, first-affected eyes with nAMD started on ranibizumab before January 1, 2009. The primary outcome was time to best-corrected visual acuity (BCVA) falling ≤35 ETDRS letters after initiating anti-VEGF therapy. Secondary outcomes included time to BCVA reaching ≥70 letters, proportion of eyes with BCVA ≥70 and ≤35 letters in 10 years, mean trend of BCVA and central retinal thickness over 10 years, and mean number of injections.
Results For our cohort of 103 patients, Kaplan-Meier analyses demonstrated median time to BCVA reaching ≤35 and ≥70 letters were 37.8 (95% CI 22.2 to 65.1) and 8.3 (95% CI 4.8 to 20.9) months after commencing anti-VEGF therapy, respectively. At the final follow-up, BCVA was ≤35 letters and ≥70 letters in 41.1% and 21%, respectively, in first-affected eyes, while this was the case for 5.4% and 48.2%, respectively, in a patient’s better-seeing eye. Mean injection number was 37.0±24.2 per eye and 53.6±30.1 at patient level (63.1% of patients required injections in both eyes).
Conclusions The chronicity of nAMD disease and its management highlights the importance of long-term visual prognosis. Our analyses suggest that one in five patients will retain good vision (BCVA ≥70 ETDRS letters) in the first-affected eye at 10 years after starting anti-VEGF treatment; yet, one in two patients will have good vision in their better-seeing eye. Moreover, our data suggest that early treatment of nAMD is associated with better visual outcomes.
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CA and HK authors contributed equally to this work.
Twitter Dun Jack Fu @dunjackfu.
Contributors CA and HK have drafted the manuscript and contributed to data acquisition, analysis and interpretation of data. SC and DJF have contributed to design of the study, interpretation of data as well as critical revision of the manuscript. DJF, LF and SW have contributed to analysis and interpretation of the data and critical revision of the manuscript. PP, RC, GM and KB have contributed to critical revision of the manuscript. SS and PAK have contributed to conception of the work, interpretation of data and critical revision of the manuscript. All the authors share accountability for all aspects of the work and have approved for the final version to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SC is funded by the GCRF UKRI (MR/P207881/1). SW is a clinical research training fellow funded by the Medical Research Council. KF is in the Roche TAE Leadership and Surgical Excellence Advisory Board. RC receives studentship support from the College of Optometrists, United Kingdom and is an employee of Google Health. KB is a consultant for Roche and Novartis; receives speaker fees from Novartis, Bayer, Allergan, Alimera, Topcon and Heidelberg Engineering. 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. 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). CA, HK, DJF, LF, PP and GM have no disclosures.
Ethics approval Approval for retrospective data collection and analysis was obtained from the Institutional Review Board at Moorfields Eye Hospital and registered as a clinical audit (reference CA17/MR/28). The study adhered to the tenets set forth in the Declaration of Helsinki. Given the retrospective nature of the study, patients did not need to give informed consent to take part in it.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement De-identified data for this study are openly available from the Dryad Digital Repository: https://doi.org/10.5061/dryad.9cnp5hqfm
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