Approximately 80% of patients who progress to neovascular age-related macular degeneration (wet AMD) will be legally blind within 3 years unless they obtain treatment with intravitreal injections, a new study explains. However, research shows, with the development of anti vascular endothelial growth factor (anti-VEGF) injections, treatment can extend useful visual acuity in another 20% of patients for the remainder of their natural lives. 

Additionally, a large proportion of patients who undergo anti-VEGF injections can retain acuity in at least 1 eye for 5 years.1 “Ongoing anti-VEGF treatment is associated with better visual outcomes and prevention of severe vision loss in a considerable proportion of patients in the long term,” the researchers stated.  

This study took a look at an important nuance regarding acuity for these patients. Rather than merely determine how many patients avoided legal blindness, it evaluated visual outcomes based on “useful vision.” This metric takes into account the patient’s abilities to read, drive, and perform other tasks.

The research took a retrospective look into the records of 3192 individual patients with wet AMD (a total of 67,700 visits). Most of the subjects (54.1%) were older than 80 years. Across the study, the patients’ mean remaining lifetime was 11 years. It measured the visual acuity at 5 and 10 years as well as over the course of the remaining lifespan of the patient in subjects between 55 years and 69 years, 70 and 79 years, 80 and 89 years, and 90 or more years old. It quantified their total treatment duration, number of injections, visual acuities, and other metrics.


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Younger age at baseline and more injections during the first year of treatment were associated with better long-term outcomes. In both driving and reading, acuity after both 5 and 10 years was better in patients who received the most injections in the first year (8 or more), followed by patients who received 6 to 7 injections during the first year of treatment. Finally, patients who had 5 or fewer injections, although improved, did not see as strong results. Also, subjects between 70 and 79 years at baseline had better outcomes than those 80 to 89 years old. Additionally, subjects with good baseline vision had the highest probability to retain good visual acuity at 5 and 10 years, as well as over their remaining lifetime. This held true regardless of age at time of presentation. 

A total of 32% of the sample retained reading VA in at least 1 eye after 5 years of treatments. Over the remaining life expectancy, 12% of the sample retained driving VA, and 15% retained reading VA in at least 1 eye.

Although anti-VEGF treatments for wet AMD can keep patients driving and reading and using their vision for various tasks for several years, a surprisingly high proportion of patients are likely to cease treatment altogether — up to half within the first year. Study researchers advocate for better methods to understand how to increase the proportion of patients who keep up with their injections to maintain good VA over their remaining lifespan.

Reference

Finger R, Puth MT, Schmid M, Barthelmes D, Guymer R, Gillies M. Lifetime outcomes of anti–vascular endothelial growth factor treatment for neovascular age-related macular degeneration. JAMA Ophthalmol. Published online October 15, 2020. doi:10.1001/jamaophthalmol.2020.3989