Repetitive intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) drugs is highly effective for improving and preserving vision in patients with neovascular AMD (Wet AMD), but some studies have linked the treatment to the progressive development of a separate condition—macular atrophy (MA).1-3

A new study weighs in on the debate with a post hoc analysis of MA data from two prospective studies that included 109 eyes from 101 patients.4 One of the studies evaluated the use of the anti-VEGF drug Lucentis (ranibizumab, Genentech) while the other looked at the use of Eylea (aflibercept, Regeneron). The study protocols were identical in each.

The team calculated MA growth rates in eyes treated with wet AMD and examined the risk factors for rapid MA growth. The risk factors they found included choroidal thicknesses of <150μm and subretinal tissue complex thicknesses greater than 96μm. “No previous studies have identified these factors as being associated with MA growth rates,” the researchers say.4

However, the study could not identify any risks associated with anti-VEGF drugs. The researchers couldn’t produce a connection between either a specific drug and MA development, or a particular number of injections. In fact, many eyes did not develop MA within two years of the onset of neovascularization and only 53.2% developed it within two years in the study; however, that proportion can reach up to 98% within seven years.4 

1. Rofagha S, Bhisitkul RB, Boyer DS, et al. Seven-year outcomes in ranibizumab-treated patients in ANCHOR, MARINA, and HORIZON: a multicenter cohort study (SEVEN-UP). Ophthalmology 2013;120:2292–9.

2. Rosenfeld PJ, Shapiro H, Tuomi L, et al. Characteristics of patients losing vision after 2 years of monthly dosing in the phase III ranibizumab clinical trials. Ophthalmology 2011;118:523–30.

3. Gillies MC, Campain A, Barthelmes D. Long-term outcomes of treatment of neovascular age-related macular degeneration: data from an observational study. Ophthalmology 2015;122:1837–45.

4. Mantel I, Zola M, Massougnes S, Dirani A, Bergin C. Factors influencing macular atrophy growth rates in neovascular age-related macular degeneration treated with ranibizumab or aflibercept according to an observe-and-plan regimen. Br J Ophthalmol. August 30, 2018. [Epub ahead of print].