Signs of Macular Atrophy in nAMD Patients Treated with anti-VEGF

Presenters at the American Academy of Ophthalmology 2020 meeting identified 3 anatomic alterations that occur in 1 or both eyes before macular atrophy develops in some patients. The poster presentation deals specifically with patients with neovascular age-related macular degeneration (nAMD) that has been treated with anti-vascular endothelial growth factor (VEGF) agents, according to the researchers.

To identify which anatomic alterations precede macular atrophy in this patient population, the team of investigators reviewed serial optical coherence tomography (OCT) scans of a large cohort of nAMD patients treated with anti-VEGF agents. Of the 342 nAMD eye scans examined from 278 patients, 47 (13.8%) developed macular atrophy.¹ The median time to macular atrophy observed was 29.6 months (interquartile range, 17.7-43.4). Foveal involvement was found in 44.7% of eyes. A loss of 3 or more lines was seen in 61.9% of the eyes with foveal macular atrophy and in 34.6% with non-foveal macular atrophy.

According to the researchers, 3 anatomic alterations occur in 1 or both eyes before macular atrophy develops. The first is collapse of vascularized pigment epithelial detachment (n = 25). The second is development of subretinal hyper-reflective material, or fibrosis, or both (n = 15). The third is large drusen and pigmentary changes that cause geographic atrophy (n = 13).

These findings suggest that neovascularization was sustaining photoreceptors and retinal pigmented epithelium. However, the researchers note that additional studies are needed to determine if VEGF suppression contributes to the regression of neovascularization and macular atrophy.

References

Akhlaq A, Amin Kherani S, Channa R, et al. Macular atrophy in nAMD Treated with anti-VEGF. Presented at: American Academy of Ophthalmology 2020 Annual Meeting; November 13-15, 2020. Abstract PO460