Proliferative age-related macular degeneration (AMD) patients with better baseline visual acuity before being treated have better visual acuity after two years of treatment with Eylea (aflibercept, Regeneron) than patients with more compromised acuity at the outset, according to a new Acta Ophthalmologica study. The study seems to promote early intervention with the anti-VEGF injection.

The observational cohort study looked at data from the Swedish Macula Register of 2,478 eyes that underwent treatment for a year and 831 eyes that underwent treatment for two years between January 2013 to December 2014.

All the treated eyes showed improvement, with a mean acuity increase from 61.3 (±13.4) Early Treatment Diabetic Retinopathy Study letters at baseline to 64.5 (±15.6) at one year and from 65.1 (±15.1) letters after two years. After two years, the eyes that started with good baseline visual acuity (more than or equal to 70 letters) lost only a mean of 2.4 (±11.3) letters, leaving them with a mean of 72.3 letters. Eyes with intermediate baseline acuity (36 to 69 letters) gained 5.7 (±14.1) and those with poor baseline acuity gained 13.2 (±18.3) letters, but each of those groups resulted in acuities less than the first group with 62.7 letters and 41 letters, respectively.

Although the eyes with the least acuity improved the most, they were still unable to achieve the acuity of them most functional eyes. And, whatever their baselines, 75% of treated eyes were stable or had actually improved visual acuity after two years.

Adrian M, Vassilev Z, Westborg I. Baseline visual acuity as a prognostic factor for visual outcomes in patients treated with aflibercept for wet age‐related macular degeneration: data from the INSIGHT study using the Swedish Macula Register. Acta Ophthalmol. September 20, 2018 [Epub ahead of print].