Vision Recovery Velocity, Momentum and Acceleration: Advanced Vitreoretinal Analytics as Measure of Treatment Efficacy for Neovascular Age-Related Macular Degeneration

Abstract

Purpose

Currently, varying treatment paradigms and different clinical trial constructs preclude cross-trial comparison between different available vascular endothelial growth factor (VEGF) inhibitors. This study aimed to review the evidence and compare the efficacy of anti-VEGF therapies for neovascular age-related macular degeneration (nAMD), and to develop metrics as a means of facilitating standardized comparison between different anti-VEGF agents within the Advanced VitreoRetinal Analytics (AVRA) model.

Methods

The study analyzed key outcomes in clinical trials of bevacizumab, ranibizumab, aflibercept, and brolucizumab, including best corrected visual acuity (BCVA), number of injections, and duration of follow-up (minimum follow-up of 48 weeks).

Results

The AVRA model includes 1) vision recovery velocity (VRV; letters per unit time), which provides a metric of letters gained or lost over time (or the speed of improvement); 2) injection momentum (InjMom; number of injections multiplied by letters per unit time; units of injections•(letters/time)), which is defined as the number of injections multiplied by VRV and describes the quantity of treatment needed to achieve a vision outcome; and 3) vision recovery acceleration (VRA; letters per unit time squared; units of letters/time²), which denotes final VRV minus initial VRV, per unit time, and describes the rate of change in letters gained or lost over time.

Conclusion

AVRA stipulates that the ideal VEGF inhibitor to treat nAMD would have a higher positive VRV (more letters gained per unit time), low InjMom (lower treatment burden requiring fewer interventions for a given visual acuity outcome), and VRA approximating zero (indicating stable vision over time). AVRA allows comparisons across different trials to determine the optimal anti-VEGF agent for the treatment of nAMD.

Keywords:

• vascular endothelial growth factor inhibitors
• neovascular age-related macular degeneration

Ethics Approval

This study was conducted in accordance with the Declaration of Helsinki. Collection and evaluation of all protected health data were performed in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner.

Disclosure

DA reports personal fees from Alcon, during the conduct of the study; being an advisory board member, consultant, and speaker for Alcon, Allergan, Bayer, Genentech, Novartis, and Regeneron; and a cofounder and equity holder of Citrus Therapeutics. EC reports being a research subinvestigator for Novartis, Bayer, Allergan, Amgen, Genentech, Chengdu Kanghong Biotechnology, and Ophthotech, outside the submitted work; a consultant for Alcon, Allergan, Chengdu Kanghong Biotechnology, Genentech, Novartis, Ophthotech, and Opthea; and a cofounder and equity holder of Citrus Therapeutics. The authors report no other potential conflicts of interest for this work.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.