A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Retina/Vitreous Panel: Sophie J. Bakri, MD,1 Jennifer E. Thorne, MD, PhD,2 Allen C. Ho, MD,3 Justis P. Ehlers, MD,4 Scott D. Schoenberger, MD,6 Steven Yeh, MD,7 Stephen J. Kim, MD8
Ophthalmology, August 2018, © 2018 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To review the evidence on the safety and efficacy of anti-vascular endothelial growth factor (VEGF) therapies for the treatment of neovascular age-related macular degeneration (AMD).
Methods: A literature search of the PubMed and Cochrane Library databases was last conducted in February 2017; there were no date restrictions, and the search was limited to studies published in English. The combined searches yielded 191 citations, 28 of which were selected because they were clinical trials and were deemed clinically relevant for the Ophthalmic Technology Assessment Committee Retina/Vitreous Panel to review in full. The panel methodologist then assigned a level of evidence rating to each study.
Results: Sixteen of the 28 citations provided level I evidence supporting the use of anti-VEGF agents for neovascular AMD, including intravitreal ranibizumab, aflibercept, and bevacizumab. Eight studies reviewed provided level II evidence, and 4 studies provided level III evidence, but only the level I studies are included in this assessment. There are long-term follow-up data on the efficacy of ranibizumab and bevacizumab (≥5 years), but these data are subject to the bias of incomplete follow-up.
Conclusions: Review of the literature indicates that intravitreal injection of anti-VEGF therapy is safe and effective for neovascular AMD over 2 years, the period for which data are available. Further research is needed to evaluate the long-term safety and comparative efficacy of these agents.
1 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
2 Division of Ocular Immunology, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MarylandDepartment of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
3 Wills Eye Hospital, Philadelphia, PennsylvaniaDepartment of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
4 Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
5 Retina Physicians & Surgeons, Inc., Dayton, Ohio
6 Byers Eye Institute, Stanford University, Palo Alto, California
7 Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
8 Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee