Severe visual impairment may still occur after anti-VEGF injections despite their efficacy in treating nAMD.
Severe visual impairment may still occur after anti-VEGF injections despite their efficacy in treating nAMD. Photo: Leo Skorin, OD. Click image to enlarge.

Intravitreal anti-VEGF injections are the current standard of care for treating neovascular age-related macular degeneration (nAMD), but vision loss still occurs in some patients. Researchers believe that the vision loss affecting this small subgroup of patients may be related to the number of intravitreal injections they receive.

They conducted a retrospective, observational study analyzing patients who experienced sudden visual decline, defined as a loss of ≥15 ETDRS letters, during anti-VEGF treatment for nAMD. A total of 1,019 eyes received treatment during the study period, with severe vision loss occurring in 15.1% of patients after a median of six injections. Ranibizumab was injected in 52.8% of cases and aflibercept in 31.9%. The researchers reported that functional recovery after three months was significant and showed no further improvement at six months.

In a recent paper for the Retina journal, the researchers also reported better visual outcomes in eyes with no substantial central macular thickness changes compared with eyes that had an increase of >20% or a decrease of >5% in thickness.

“To our knowledge, this is the first real-life study exploring the incidence, OCT correlation and intermediate prognosis of severe visual acuity loss during anti-VEGF treatment in patients with nAMD,” the researchers concluded in their paper. “We’ve shown that a ≥15 ETDRS letter loss between two consecutive intravitreal injections wasn’t unusual in patients receiving intravitreal injection treatment. As it frequently occurred within nine months of diagnosis and two months after the last intravitreal injection, close follow-up and a proactive regimen should be preferred, at least in the first year.”

Grassi MO, Monteleone G, Pozharitskiy N, et al. Severe visual loss during anti-VEGF intravitreal injections in neovascular age-related macular degeneration: timing, prognosis and optical coherence tomography findings. Retina. March 9, 2023. [Epub ahead of print].