Ten-Year Treatment Outcomes of Neovascular Age-Related Macular Degeneration from two regions.

Abstract

PURPOSE\nTo report and compare 10-year treatment outcomes of vascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration (nAMD) from Australia and New Zealand (ANZ) and Switzerland.\n\n\nDESIGN\nRetrospective, comparative, interventional case series.\n\n\nMETHODS\nWe analyzed 712 treatment-naive eyes (ANZ - 474; Switzerland - 321) starting anti-VEGF for nAMD in routine clinical practice between January 1, 2006 and December 31, 2008 tracked in the prospectively designed observational database - the Fight Retinal Blindness! Registry. The primary outcome was mean change in visual acuity (VA in logMAR letters) in eyes that completed 10 years of treatment.\n\n\nRESULTS\nThe mean VA in 132 eyes (28%) from ANZ that completed 10 years of treatment dropped by 0.9 letters from baseline (95% Confidence Interval: -4.9, 3.1) (p=0.7) with 42% achieving ≥ 20/40, while the 37 eyes (12%) from Switzerland lost 14.9 letters (-24, -5.7) (p<0.001) with 35% achieving ≥ 20/40. Eyes from ANZ received more injections than eyes from Switzerland over 10 years (a median of 53 vs 42) from fewer visits with better disease control (proportion of visits with active disease: 38% vs 69%), suggesting a treat and extend regimen versus pro re nata. Macular atrophy and subretinal fibrosis were the main reasons for 10 letter loss in the subset of eyes analyzed retrospectively. The mean VA of eyes from both regions that discontinued treatment within 10 years had fallen below the baseline at their final visit.\n\n\nCONCLUSIONS\nEyes with nAMD may achieve satisfactory long-term visual outcomes if they receive adequate treatment. Central macular atrophy does not develop universally in eyes on long-term treatment with VEGF inhibitors as previously feared. Visual outcomes were better in eyes from ANZ, likely because they received more injections.