By Rahul N. Khurana, MD; SriniVas R. Sadda, MD
    AAO 2014

    In this interview from AAO 2014, Dr. SriniVas Sadda discusses whether anti-VEGF therapy in cases of neovascular AMD influences the development of geographic atrophy. The major anti-VEGF trials--CATT, IVAN and HARBOR--identified a significant number of patients with no detectable atrophy at baseline who later developed atrophy following anti-VEGF therapy. Dr. Sadda and his colleagues conducted a post-hoc analysis of the HARBOR trial, finding that atrophy rates were higher with monthly compared with PRN treatment. Cysts, atrophy in the fellow eye at baseline, and absence of subretinal fluid were risk factors for developing atrophy. Despite these findings, Dr. Sadda believes clinicians should not alter their treatment protocols. These post-hoc studies have not established causation or even association between atrophy and any anti-VEGF regimen. Of greatest clinical import, all patients who received anti-VEGF therapy experienced improved visual acuity through 2 years, irrespective of any atrophy.