Intravitreal anti-VEGF injections effectively slow the progression of AMD, but therapy requires frequent—and regular—treatment. Many patients are lost to follow-up, whether from avoidance of unpleasant injections, lack of access to healthcare, transportation or time off from work or comorbidities, and this lapse in treatment can result in lost vision. A recent study analyzed outcomes of patients who experience a lapse in treatment and found that this results in poorer results.
The retrospective chart review evaluated 3,304 patients who experienced a lapse in treatment of at least three months. The team collected demographic information, macular thickness measurements and visual acuity data at baseline, the first post-lapse appointment and at three, six and 12 months after the lapse. These results were compared with a control group.
Their findings revealed that lapse (n=241) and control (n=241) patients had similar baseline visual acuity and central subfield thickness (visual acuity 20/63 vs. 20/63 and central subfield thickness 252.4µm vs. 259.8µm). However, after a lapse, patients experienced a significant increase in central subfield thickness compared with controls (279.4µm vs. 253.7µm). This increase normalized when treatment resumed (259.1µm vs. 246.8µm).
In addition to central subfield thickness increases, lapse patients also experienced visual acuity loss compared with controls (20/100 vs. 20/63) that didn’t recover over the 12-month follow-up period.
“The findings in this study, along with the previous literature, provide insights into several important clinical considerations,” the researchers wrote in their paper in Retina. “First, it conforms that current clinical practice patterns requiring frequent follow-up are crucial to avoid delays in treatment when the retinal fluid is identified. More interestingly, it demonstrates that the time required for untreated disease to cause long-term and/or permanent damage is rather short, with the average lapse length being 5±3.7 months and the most frequent lapse lengths in the study being three months (n=96) and four months (n=67).”
The researchers concluded that patients with AMD who experience lapses in their anti-VEGF treatment are at risk for poorer outcomes. “Despite the efficacy of anti-VEGF treatment in resolving gross anatomical derangements, the damage performed to the retina on a cellular level and the deterioration of the visual acuity may, in many instances, be irreversible,” they wrote in their paper.
Greenlee TE, Wang VY, Kang H, et al. Consequences of lapses in treatment with vascular endothelial growth factor inhibitors in neovascular age-related macular degeneration in routine clinical practice. Retina. 2021;41:581-7.