Vision protection therapy (VPT) may reduce risk for neovascular conversion in nonexudative (dry) age-related macular degeneration (AMD), an analysis of real-world data published in Clinical Ophthalmology shows. 

Data for this study were sourced from a database that aggregates electronic medical record information from ~300 retinal subspecialty practices in the United States. Patients (N=392,250) with dry AMD who were active in the database between 2016 and 2020 were eligible for this study. Eyes treated at a single center that performed VPT (n=830), defined as regular periodic subthreshold diode micropulse (SDM) laser treatment, were propensity matched in a 1:10 ratio with eyes receiving standard care (n=8300) at other centers. The primary endpoint was the conversion from dry to wet AMD, defined as the change in coding from dry to wet AMD or the initiation of anti-vascular endothelial growth factor therapy (VEGF).

The VPT (n=449) and control (n=6567) cohorts were aged mean 77.0 (standard deviation [SD], 10.1) and 76.6 (SD, 9.7) years, 62.1% and 62.1% were women, 55.7% and 57.8% had hypertension, and 64.4% and 56.8% used age-related eye disease study antioxidant vitamins, respectively.


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The VPT and control cohorts had an average follow-up of 467.8 (SD, 484.3) and 676.6 (SD, 553.8) days and had 9.0 (SD, 8.5) and 9.2 (SD, 9.2) encounters, respectively.

Among the VPT cohort, 68.1% received VPT and the average number of treatments was 5.1 (range, 1.0-18.0).

Conversion to wet AMD occurred among 1.2% of the VPT cohort and 15.0% of the controls, indicating lower risk for neovascular conversion (hazard ratio [HR], 13.04; 95% CI, 5.5-18.5). The cumulative probability of neovascular conversion was 3.9% at four years for the VPT group compared with 30.3% for the standard care recipients.

Similarly, visual acuity tended to worsen among the standard care recipients and improve for the VPT group. No statistical test was performed due to the imbalance in cohort sizes.

This study may have been limited by sourcing the experimental cohort from a single center and the controls from multiple, different centers.

These data indicated that standard care for dry AMD, lifestyle and dietary counseling coupled with use of antioxidant vitamins, did not prevent neovascular conversion as effectively as VPT with SDM laser treatment. If confirmed by additional studies, VPT could be established as a benchmark therapy for dry AMD.

Disclosure: Multiple authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference


Luttrull JK, Gray G. Real world data comparison of standard care vs SDM laser vision protection therapy for prevention of neovascular AMD. Clin Ophthalmol. 2022;16:1555-1568. doi:10.2147/OPTH.S366150