Increased follow-ups and closer monitoring may be why wet AMD patients on anti-VEGF therapy don't seem to have greater glaucoma progression. Photo: NEI. Click image to enlarge.
For patients with both age-related macular degeneration (AMD) and glaucoma, the possibility of developing long-term pressure elevations due to anti-VEGF injections has been a concern, since IOP typically rises and then falls following an injection. Fortunately, a study in American Journal of Ophthalmology investigated whether anti-VEGF injections affect the rate of glaucoma progression in patients with a pre-existing glaucoma diagnosis and found that eyes that received anti-VEGF injections for exudative AMD didn’t have an increased risk for developing glaucoma compared with controls.
The retrospective review included 707 eyes with exudative AMD, as well as 1,008 age- and sex-matched eyes with non-exudative AMD and without AMD. Some eyes had glaucoma or glaucoma suspect diagnoses, and the researchers reviewed their injection and glaucoma data, including perimetry and SD-OCT. Qualitative progression was determined by provider notes and quantitative progression was assessed based on mean deviation, perimetry, IOP and RNFL thickness.
The researchers found no difference in:
glaucoma or subject prevalence at the initial presentation for eyes treated with anti-VEGF injections and non-exudative AMD or controls.
cumulative five-year probability of new glaucoma after anti-VEGF injections for AMD vs. non-exudative AMD or controls.
qualitative progression of glaucoma in injection cohort vs. non-exudative AMD or controls.
The team reported that the rate of mean deviation change in eyes receiving injections was similar to that of non-exudative AMD eyes but greater than that of the control eyes without AMD. Eyes receiving injections also required more topical glaucoma medications vs. non-exudative AMD eyes and received more glaucoma laser treatments than controls. However, they didn’t need more frequent incisional glaucoma surgery vs. controls or non-exudative AMD.
“Eyes with exudative AMD receiving injections didn’t have an elevated risk of new glaucoma or glaucoma suspect diagnosis,” the researchers concluded in their paper. “Similarly, eyes receiving injections didn’t have more rapid progression of pre-existing glaucoma.
“We found that more eyes receiving injections needed topical glaucoma medications, glaucoma-specific laser treatments and surgeries than those in the no AMD cohort,” they continued. “We attribute this trend to the greater number of follow-up visits and monitoring in eyes with exudative AMD receiving injections, which likely increases the degree of glaucoma monitoring and probability of starting glaucoma treatment—even after excluding the glaucoma suspects from analysis, this trend seemed to persist.”
Shah SM, Boopathiraj N, Starr MR, et al. Risk, prevalence, and progression of glaucoma in eyes with age-related macular degeneration treated with intravitreal anti-VEGF injections. Am J Ophthalmol 2022. August 2, 2022. [Epub ahead of print].