A large analysis based on electronic health records as found that anti-VEGF injections may not be helping wet AMD patients as much as we thought. Researchers found that anti-VEGF injections are administered relatively infrequently with moderate anatomic and limited visual acuity (VA) improvements in patients with wet AMD.
This retrospective observational cohort study analyzed the records of 37,021 eyes of 30,106 patients who were followed for seven years, making it the largest study conducted to-date on wet AMD.
Over the first 12 months, the team found that, on average, patients visited the ophthalmologist an average of 8.1 times and received 6.0 intravitreal anti-VEGF injections, 7.2 OCT scans and 5.3 fluorescein angiography procedures per study eye. During this time, they also noted that mean central retinal thickness declined from 320μm to 271μm and mean VA increased from 60.3 to 61.0 ETDRS letters.
Twelve months after initiating treatment with bevacizumab, ranibizumab or aflibercept, the investigators discovered that 19.3%, 15.8% and 15.5% of eyes, respectively, showed at least a 10-letter gain; whereas 13.2%, 14.7% and 14.4% of eyes, respectively, showed at least a 10-letter loss. They noted that the mean change in VA from baseline to 12 months increased linearly with the number of anti-VEGF injections (+1.79 ETDRS letters for eyes that received at least seven injections vs. -0.95 letters for eyes that received less).
Further analysis also indicated a significant association between the number of anti-VEGF injections and the change in VA, with each additional injection producing a gain of 0.37 ETDRS letters. Similarly, the magnitude of the reduction in central retinal thickness from baseline to 12 months increased linearly with the number of anti-VEGF injections.
At 24 months, mean change from baseline was -1.5 ETDRS letters. “Findings at 24 months, stratified by baseline VA, were similar to those at 12 months, with the greatest vision gain experienced by eyes with the worst VA at baseline,” the report explained.
|Kiss S, Campbell J, Almony A, et al. management and outcomes for neovascular age-related macular degeneration: analysis of US electronic health records. Ophthalmology. February 27, 2020. [Epub ahead of print].|