Study: Lapses in Intraocular Injections Can Lead to Irreversible Acuity Loss

Patients with neovascular age-related macular degeneration who miss appointments with their ophthalmologist are at risk for poorer outcomes than those who have no lapses, a new study shows. While it’s true that some metrics — such as macular thickness — can see strong improvement when the treatment resumes, the patients’ visual acuity does not recover, the researchers said.¹

Patients being treated with anti-vascular endothelial growth factor (VEGF) drugs neglect to follow up with their ophthalmologist up to 22.2% of the time, according to one prior study.² Those patients experience significant increase in central subfield thickness (CST), according to the current research published in Retina. This increase can, eventually, normalize upon the resumption of treatment. However, patients also undergo decreases in visual acuity that trend downward over time, even after CST normalizes.¹ 

The retrospective study looked at the records of 241 patients who skipped out on their treatments for longer than 3 months and another 241 control patients with similar baseline visual acuity and CST (252.4 ± 63.2 mm vs 259.8 ± 66.2 mm, P =.21). 

Each subject underwent visual acuity tests and CST measurement using spectral-domain optical coherence tomography (SD-OCT) at their visit preceding their lapse in care as well as at the visit date immediately following their return (post-lapse) and at subsequent follow-up visits at 3, 6, and 12 months. The visual acuity was also collected for all patients at the time of their first anti-VEGF injection. 

The researchers were able to show that patients who lapsed experienced a significant increase in CST compared with controls (279.4 ± 86.9 mm vs 253.7 ± 65.9 mm, P =.01), but that it was able to normalize when they resumed treatment (259.1 ± 79 mm vs 246.8 ± 57.6 mm, P =.06). The control group’s CST remained relatively constant throughout the study, according to investigators.

However, the researchers did record an initial drop-off in visual acuity for the lapse group from a mean acuity of 20/63 at baseline to 20/100 after 12 months. That drop-off never recovered. The control group, who experienced a 20/63 mean acuity at baseline and 20/80 after 12 months, did not experience “notable changes” in vision, according to investigators.

“The severity of these outcomes is particularly concerning when the lapse group is viewed in parallel with the controls,”  the researchers concluded. “This study further validates that patients who experience a lapse in care suffer notable losses in visual health.”

References

1. Greenlee T, Wang V, Kang H, et al. Consequences of lapses in treatment with vascular endothelial growth factor inhibitors in neovascular age-related macular degeneration. Retina. Published online July 8, 2020. doi: 10.1097/IAE.0000000000002888
2. Obeid A, Gao X, Ali FS, et al. Loss to follow-up among patients with neovascular age-related macular degeneration who received intravitreal anti–vascular endothelial growth factor injections. JAMA Ophthalmol. 2018;136:1251. doi: 10.1001/jamaophthalmol.2018.3578