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Multicenter Study
. 2020 Dec 1;138(12):1234-1240.
doi: 10.1001/jamaophthalmol.2020.3989.

Lifetime Outcomes of Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

Robert P Finger  1 , Marie-Therese Puth  2 , Matthias Schmid  2 , Daniel Barthelmes  3   4 , Robyn H Guymer  5   6 , Mark Gillies  3
Affiliations
Multicenter Study

Lifetime Outcomes of Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

Robert P Finger et al. JAMA Ophthalmol. .

Abstract

Importance: Neovascular age-related macular degeneration (nAMD), the largest single cause of irreversible severe vision loss in high-income countries, can now be treated with vascular endothelial growth factor (VEGF) inhibitors, but to our knowledge, no data on lifetime outcomes are available.

Objective: To determine visual acuity (VA) outcomes of anti-VEGF treatment for nAMD in both eyes for patients' remaining lifetime.

Design, setting, and participants: Multistate modeling using real-world cohort data of 3192 patients with nAMD (>67 000 visits) treated in routine eye clinics in Australia, New Zealand, and Switzerland. Data were analyzed between 2007 and 2015.

Exposures: Intravitreal anti-VEGF treatment at the treating physician's discretion and prospective data collection in standardized registry.

Main outcomes and measures: Visual acuity in both eyes over the remaining lifetime.

Results: For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% CI, 345-400) of the sample retained driving VA and an estimated 15% (n = 463; 95% CI, 434-495) reading VA in at least 1 eye. At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped out. Younger age at baseline and more injections during the first year of treatment were associated with better long-term outcomes.

Conclusions and relevance: Anti-VEGF treatment was associated with preserved useful visual acuity in almost 20% of patients over their average remaining lifetime. More than 80% of patients will cease treatment over that time, having likely experienced a deterioration of vision beforehand. This is a remarkable outcome compared with outcomes without intervention, which lead to legal blindness within 3 years of disease onset in 80% of those affected. These findings underline the public health necessity of providing anti-VEGF treatment to persons in need.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schmid reported personal fees from Pixium Vision outside the submitted work. Dr Barthelmes reported grants from Novartis and Bayer during the conduct of the study and personal fees from Alcon outside the submitted work; in addition, Dr Barthelmes had a patent to Fight Retinal Blindness software issued. Dr Guymer reported personal fees from Roche outside the submitted work. Dr Gillies reported grants and personal fees from Novartis and Bayer during the conduct of the study and outside the submitted work. Dr Finger reported personal fees from Novartis, Bayer, Roche/Genentech, Allergan, Alimera, Santhera, Opthea, Inositec, and Ellex outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Estimated Prevalence Rates (With 95% CIs) of Patients With Reading and Driving Visual Acuity, Stratified by Number of Intravitreal Injections Received During the First Year of Treatment and Age at Baseline After 5 and 10 Years
In each stratum, pairwise differences are statistically significant at the 5% level because the respective 95% confidence intervals do not overlap.
See this image and copyright information in PMC

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