• AREDS2: Long-Term VA Following Anti-VEGF

    Written By: Jean Shaw
    Selected By: Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, January 2020

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    Keenan et al. set out to analyze best-corrected visual acuity (BCVA) out­comes of patients with wet age-related macular degeneration (AMD) after intravitreal injections of anti-VEGF drugs. They found that mean BCVA decreased by about 1.5 to 2 letters per year—and that, at five years, BCVA was 20/40 or better in approximately 50% of eyes and 20/200 or worse in 14%.

    This study is Report No. 19 of the Age-Related Eye Disease Study 2 (AREDS2). A total of 986 AREDS2 participants (1,105 eyes) met the inclusion criteria (no late AMD, BCVA 20/100 or better, and no previous anti-VEGF injections).

    All participants received at least one anti-VEGF injection during follow-up; decisions regarding treatment were made by local ophthalmologists during normal clinical care.

    The primary outcome measures were mean refracted BCVA and the propor­tions of eyes with BCVA of 20/40 or better and 20/200 or worse. An explor­atory outcome measure was the mean number of anti-VEGF injections, as reported by the treating ophthalmolo­gists.

    All told, 977 of the 986 participants (99.1%) had at least one post-treatment visit. During the study, the percentage of eyes with a BCVA of 20/40 or better declined from 59.3% at the first annual study visit after the first injection to 49.7% by the fifth annual exam. In contrast, the percentage of eyes with a BCVA of 20/200 or worse rose from 5.5% to 14.4% during the same time period.

    The mean annual numbers of injec­tions per eye were 2.9 during year 1 and 3.9, 3.3, 3.1, and 3.0 in the suc­ceeding years of the study. Patients received a mixture of ranibizumab, bevacizumab, and, in fewer cases, aflibercept injections; in addition, they were treated under several dosing regimens (including treat-and-extend, fixed interval, and as-needed).

    The authors noted that although the treating ophthalmologists were making decisions outside of a randomized clin­ical trial protocol, the participants were part of the AREDS2 cohort. Thus, this study does not fully represent a real-world setting. Nonetheless, the data may be useful in assessing the long-term effects of anti-VEGF treatment for wet AMD, they said.

    The original article can be found here.