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Lifetime Outcomes of Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

Year: 2020

Type: article

Abstract: Importance: Neovascular age-related macular degeneration (nAMD), the largest single cause of irreversible severe vision loss in high-income countries, can now be treated with vascular endothelial growth factor (VEGF) inhibitors, but to our knowledge, no data on lifetime outcomes are available. Objective: To determine visual acuity (VA) outcomes of anti-VEGF treatment for nAMD in both eyes for patients' remaining lifetime. Design, Setting, and Participants: Multistate modeling using real-world cohort data of 3192 patients with nAMD (>67 000 visits) treated in routine eye clinics in Australia, New Zealand, and Switzerland. Data were analyzed between 2007 and 2015. Exposures: Intravitreal anti-VEGF treatment at the treating physician's discretion and prospective data collection in standardized registry. Main Outcomes and Measures: Visual acuity in both eyes over the remaining lifetime. Results: For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% CI, 345-400) of the sample retained driving VA and an estimated 15% (n = 463; 95% CI, 434-495) reading VA in at least 1 eye. At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped out. Younger age at baseline and more injections during the first year of treatment were associated with better long-term outcomes. Conclusions and Relevance: Anti-VEGF treatment was associated with preserved useful visual acuity in almost 20% of patients over their average remaining lifetime. More than 80% of patients will cease treatment over that time, having likely experienced a deterioration of vision beforehand. This is a remarkable outcome compared with outcomes without intervention, which lead to legal blindness within 3 years of disease onset in 80% of those affected. These findings underline the public health necessity of providing anti-VEGF treatment to persons in need.

Source: JAMA Ophthalmology

DOI: 10.1001/jamaophthalmol.2020.3989

Authors: Robert P. Finger, Marie-Therese Puth, Matthias Schmid, Daniel Barthelmes, Robyn H. Guymer, Mark Gillies