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Utility of Intravitreal Anti-VEGF Treatment in Patients With Neovascular AMD and Poor Visual Acuity
TAKE-HOME MESSAGE
- This retrospective study investigated the utility of continuing intravitreal anti-VEGF treatment in eyes with neovascular age-related macular degeneration (nAMD) with poor visual acuity. Notably, continued anti-VEGF therapy maintained paracentral vision, preserved lesion size, and reduced the rates of subretinal hemorrhage.
- Continued anti-VEGF therapy may be clinically useful in eyes with nAMD with poor vision, where treatment might otherwise be stopped.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To investigate the significance of intravitreal anti-vascular endothelial growth factor treatment in patients with neovascular age-related macular degeneration and poor visual acuity.
METHODS
Retrospective study of patients with neovascular age-related macular degeneration with baseline best-corrected visual acuity of ≤20/200. Patients were divided into regular treatment and scarce treatment groups according to whether they underwent consecutive intravitreal anti-vascular endothelial growth factor treatments at intervals of ≤4 months or not.
RESULTS
A total of 131 eyes were included: 87 and 44 eyes in the regular treatment and scarce treatment groups, respectively. The regular treatment group showed significantly improved preservation of lesion size at both Years 1 and 2, with significantly fewer incidences of new subretinal hemorrhage. Improvements in visual acuity, reduction in central subfield macular thickness, and maximal height of choroidal neovascularization were significantly favorable in the regular treatment group at Year 1, and central subfield macular thickness was significantly decreased at Year 2. Survival analysis revealed that the regular treatment group had significantly greater preservation of visual acuity and lesion size than that in the scarce treatment group.
CONCLUSION
Maintaining intravitreal anti-vascular endothelial growth factor treatment for patients with neovascular age-related macular degeneration and poor vision showed significant advantages in visual acuity and lesion size stability and reduced the incidence of new subretinal hemorrhage, which suggests preservation of paracentral vision.
Additional Info
Disclosure statements are available on the authors' profiles:
INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION AND POOR VISUAL ACUITY
Retina (Philadelphia, Pa.) 2024 Sep 01;44(9)1486-1494, JS Song, MS Kim, K Joo, SJ Park, SJ Woo, KH ParkFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Song and co-authors reported the results from a retrospective cohort study that compared the clinical outcomes in patients with neovascular age-related macular degeneration (nAMD) with poor vision who received anti-VEGF therapy as a regular treatment (RT; consecutive injections after a treat-and-extend protocol) versus as a scarce treatment (ST). The current study confirmed several previously reported data, indicating that RT is superior to ST in achieving visual acuity and neovascular lesion stability in patients with nAMD. These findings demonstrate the benefit of using anti-VEGF therapy for advanced nAMD.
However, this study did not provide anatomical and functional criteria for continuing RT or switching to ST in the late stages of nAMD; for instance, whether or not the presence of intraretinal fluid or subretinal fluid should be an indication for RT rather than ST. Notably, the visual outcomes of late nAMD were also determined by the size of geographic atrophy (GA). However, Table 3 shows that, from the first year to the second year of follow-up, GA size increased by 0.1 mm2 in the RT group, whereas GA size did not change in the ST group. The increased GA size should have been reflected in worse visual outcomes. Therefore, whether more anti-VEGF injections result in better outcomes remains a question in the treatment of advanced nAMD.