A large, retrospective analysis of patients who received treatment with anti-VEGF injections for neovascular AMD (nAMD) or diabetic macular edema (DME) found better maintenance of driving vision at 4 years in patients who received more frequent injections during their first year of treatment. Though injection frequency was not assessed over subsequent years, these findings reinforce the importance of early, frequent treatment to potentially prolong driving ability for patients with these diseases.
Study Design
In this retrospective analysis utilizing the Vestrum Health database, the association between anti-VEGF treatment frequency and maintenance of driving vision was assessed in patients treated for nAMD or DME. Data from more than 12,000 eyes with nAMD and 4400 eyes with DME were included. Patients met inclusion criteria if they had undergone treatment for at least 1 year and were followed for a minimum of 4 years. Eyes were analyzed in groups based on the number of injections received during the first year of treatment (1–5 injections, 6–7 injections, or ≥8 injections). Driving vision was defined as Snellen visual acuity (VA) of 20/40 or better in the better-seeing eye.
Outcomes
In eyes treated for nAMD, the estimated probability of maintaining driving vision was 94%, 81%, 67%, and 56% at years 1, 2, 3, and 4, respectively. In eyes treated for DME, the same probabilities were 96%, 87%, 79%, and 72%, respectively. Risk factors for loss of driving vision were older age, worse index VA, presence of geographic atrophy, and worse baseline diabetic retinopathy severity. Conversely, greater anti-VEGF treatment frequency in year 1 was associated with improved maintenance of driving vision to year 4.
Limitations
The study is limited by the retrospective nature of the report and its use of data derived from health databases that may be subject to coding and entry errors. Not all factors could be reliably controlled for over the 4-year study period, including treatment intervals and switching of intravitreal agents. Also, the study may be subject to selection bias, as at least 4 years of follow-up were required for inclusion and this may select for patients most adherent to treatment recommendations.
Clinical Significance
In patients treated with anti-VEGF therapy over 4 years, the probability of maintaining driving vision was 56% in patients treated for nAMD and 72% in patients treated for DME at year 4. Greater treatment frequency was associated with better maintenance of driving vision, underscoring the importance of early detection and treatment of these common retinal diseases.
Financial Disclosures: Dr. M. Ali Khan discloses financial relationships with Allergan, Apellis Pharmaceuticals, Genentech (Consultant/Advisor); Regeneron Pharmaceuticals (Grant Support).