Anti-VEGF Therapy Superior in Eyes With Thick Pigment Epithelial Detachment

Thinner subretinal hyper-reflective material in nAMD eyes following long-term anti-VEGF therapy also correlated with better vision.

Among individuals with neovascular age-related macular degeneration (AMD), better vision after long-term anti-vascular endothelial growth factor (VEGF) therapy was associated with thicker pigment epithelial detachment (PED) and thinner subretinal hyper-reflective material (SHRM), according to results published in the British Journal of Ophthalmology.

Patients (N=175; eyes n=203) who had treatment-naïve neovascular AMD were retrospectively reviewed for this study. Records from patients treated with long-term anti-VEGF between 2005 and 2018 at Retina Consultant of Huston; Emory Eye Center; and University of California, Los Angeles Eye Centers were assessed for visual outcomes on the basis of spectral domain optical coherence tomography scans.

Patients were aged mean 82.63 (standard deviation [SD], 9.13) years, logMAR was 0.65 (SD, 0.61), total anti-VEGF injections received was 41.04 (SD, 26.41), with an average of 5.19 (SD, 3.20) injections per year, and follow-up time was 7.84 (SD, 1.70) years.

Eyes were stratified into good vision (best corrected visual acuity [BCVA] ≥20/40; 32.5%), intermediate vision (BCVA 20/200-20/40; 44.8%), and poor vision (BCVA ≤20/200; 22.7%).

Patients who had the poorest vision received the fewest number of overall anti-VEGF therapy injections (P =.005) and injections per year (P =.03).

These groups differed significantly for PED (P <.001), maximum PED thickness in the foveal central subfield (P <.001), maximum SHRM thickness (P <.001), maximum SHRM thickness in the foveal central subfield (P <.001), and maximum PED thickness (P =.001), in which the poor vision cohort had smaller PED and larger SHRM.

Visual acuity at the final follow-up was positively associated with SHRM (r, 0.637; P <.001) and negatively associated with PED (r, -0.277; P <.001) and combined PED and choroid thickness (r, -0.346; P <.001).

Altogether, eyes with only SHRM had the poorest visual acuity (logMAR, 1.25) followed by eyes without SHRM or PED (logMAR, 0.43; P <.001), and eyes with only PED had the best vision (logMAR, 0.29; P <.001). Eyes with only PED or no PED or SHRM did not differ on the basis of BCVA (P =.210).

This study was limited by its retrospective design and the investigators were unable to assess whether management strategies aimed at increasing PED thickness improved the efficacy of anti-VEGF therapy.

The study authors concluded that among eyes with neovascular AMD, thicker PED, and thinner SHRM are associated with better visual acuity after long-term anti-VEGF therapy.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Fang M, Chanwimol K, Maram J, et al. Morphological characteristics of eyes with neovascular age-related macular degeneration and good long-term visual outcomes after anti-VEGF therapy. Br J Ophthalmol. Published online September 24, 2021. doi:10.1136/bjophthalmol-2021-319602