Ten-Year Real-World Outcomes of Anti-Vascular Endothelial Growth Factor Therapy in Neovascular Age-Related Macular Degeneration

Abstract

Background

Neovascular age-related macular degeneration (nAMD) has been treated with anti-vascular endothelial growth factor (anti-VEGF) therapy since 2006 with initial efficacy evidence of 2 years. In many, long-term therapy is required, and evidence for benefit is required from real-world data collection.

Methods

Retrospective review of electronic medical records of a consecutive series of patients treated with anti-VEGF therapy for nAMD over a 10-year period. Age, lens status and loss to follow-up was recorded. Primary outcome was change in VA at 10 years; secondary outcomes included proportion of eyes losing <15 letters at 3, 5, 7 and 10 years, number of injections and anatomic outcome.

Results

Of 196 patients (197 eyes), 90 patients had 10 years of follow-up data. Visual acuity (VA) declined by −11.2 letters (p=0.001), but 63.3% of eyes lost ≤15 letters. The proportion of eyes maintaining ≥70 letters was 17.7%, and the mean number of injections (±SD) was 47 ± 16. Retinal fluid was still present in 72.2% of eyes at 10 years. Forty-six percent of patients continued to receive anti-VEGF injections 10 years after treatment was commenced.

Conclusion

Anti-VEGF treatment for nAMD over a ten-year period showed 63.3% of eyes lost ≤15 letters. Eyes with better baseline vision were more likely to continue receiving anti-VEGF treatment, but the frequency of injection treatment decreased.

Keywords:

• neovascular age-related macular degeneration
• visual acuity
• real-world
• anti-vascular endothelial growth factor injections

What This Paper Adds

• Maintaining anti-VEGF intravitreal injection therapy for nAMD sustains vision over a 10-year period with 63.3% of eyes losing <15 letters VA after 10 years of treatment.

• Eyes with better baseline vision were more likely to continue receiving anti-VEGF injections.

• The number of injections required to maintain vision decreases over the 10-year period.

Disclosure

J. DaCosta has received a travel grant from Alimera. J. Talks serves on advisory boards for Bayer, Novartis, Allergan, Alimera and participated in research for Bayer, Novartis, Allergan, Alimera, Roche and Boehringer Ingelheim. The authors report no other conflicts of interest in this work.