Changes in Treatment Paradigms and AMD Outcomes
Ophthalmology Retina, August 2021
Schwartz et al. set out to describe treatment strategies for neovascular age-related macular degeneration (AMD) over a decade and determine their impact on visual outcomes. They found that, despite the evolution in treatment, patients continue to lose vision after the first year of anti-VEGF injections.
For this retrospective study, the researchers analyzed electronic health records from 27 National Health Service secondary care providers in the United Kingdom. Treatment-naive patients who received at least three intravitreal anti-VEGF injections in their first six months of follow-up were included. Those with a previous diagnosis of retinal vein occlusion, diabetic macular edema, or proliferative diabetic retinopathy were excluded. Eyes with at least three years of follow-up were grouped by years of treatment initiation, and three-year outcomes were compared between the groups.
A total of 13,705 patients (15,810 eyes) were included. All patients were treated between September 2008 and December 2018, and 194,904 injections were provided. Visual acuity (VA) improved from baseline during the first year but dropped in the second and third years of treatment, a trend that did not change over time. Although an increasing proportion of patients retained functional VA and were able to continue driving as the decade progressed, this was linked to a trend of better baseline VA at start of treatment.
The data suggest that these results may be related to suboptimal treatment patterns, the researchers said. They noted that rethinking treatment strategies may be warranted, “possibly on a national level or through the introduction of longer-acting therapies.”
The original article can be found here.