Preventing Conversion to Neovascular AMD
By Jean Shaw
Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
JAMA Ophthalmology, May 2021
Heier et al. evaluated whether intravitreal injections of aflibercept can be used as a prophylactic treatment against conversion to neovascular age-related macular degeneration (AMD) in high-risk eyes. They did not find evidence to support this strategy.
For this randomized study, which was conducted at four U.S. clinical sites, the researchers enrolled 128 patients who had intermediate AMD in one eye (study eye) and neovascular AMD in the other. Intermediate AMD was defined as the presence of more than 10 medium drusen, at least one large druse, and/or retinal pigmentary changes. The patients were randomized to receive either 2-mg injections of aflibercept or sham injections on a quarterly basis in the study eye. The primary endpoint was the proportion of patients who experienced conversion to neovascular AMD at month 24, as characterized by the development of choroidal neovascularization.
For this analysis, data were available on 127 patients (mean age, 76.5 years). Of these, 63 received aflibercept, and 64 had sham injections. The two groups were balanced with regard to demographic and baseline characteristics. By month 24, six patients (9.5%) in the aflibercept group and seven (10.9%) in the sham cohort developed neovascular AMD in the study eye (p = .98). Patients who had had neovascular AMD in their fellow eye for more than two years at baseline were less likely to experience conversion to neovascular AMD in the study eye. In addition, most of the conversions took place during the first year of the study.
Based on these results, the use of intravitreal anti-VEGF injections as prophylaxis against conversion to neovascular AMD is not recommended at this time.
The original article can be found here.