Researchers from Switzerland and the United States found patients with neovascular age-related macular degeneration (nAMD) experienced a decline in their visual acuity and underwent injection treatments more often over a four-year period. In addition, the investigation reported an increase in the proportion of eyes that received intravitreal anti-VEGF treatments beyond the recommended dosage. All of this may be in an effort to stave off continued visual acuity loss and disease progression, according to the study published in Ophthalmology Retina.

The study is the largest electronic medical record (EMR) analysis to evaluate the treatment patterns and long-term visual outcomes in neovascular AMD patients in the United States, the researchers said.

The real-world study included 98,821 eyes of 78,885 patients who had anti-VEGF therapy between 2012 and 2015.

The investigation found baseline visual acuity was similar for years 2012–2014, but lower in 2015. In eyes that had a four-year follow-up, the study found visual acuity improved in the first year, but declined steadily, with an average of -5.2 ETDRS letters by the fourth year of follow-up. Additionally, the average number of injections dropped each year of the study from 7.5 in 2012 to 6.4 in 2015.

By year four, 36.7% of eyes had dosing intervals of eight weeks or less, while 21.2% received treatment at 12 or more weeks. Eyes treated at less than eight weeks increased 40% from year one to year four. Also of note: for patients treated bilaterally, 32% received the first treatment in the better-seeing eye, and 68% received the first treatment in an eye with vision the same or worse than the fellow-eye. This trend was evident across all years in the study.

“This study highlights the wealth of data contained in EMR databases for evaluating longitudinal treatment patterns and outcomes in patients with nAMD following anti-VEGF therapy,” the researchers wrote in their paper on the study. 

Khanani AM, Skelly A, Bezlyak V, et al. A retrospective, real-world evidence study of patients with neovascular age-related macular degeneration in the USA. Ophthalmology Retina. September 27, 2019. [Epub ahead of print].