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13-12-2018 | Ophthalmology | News | Article

Predictors of poor outcome with anti-VEGF therapy identified for nAMD

medwireNews: Researchers from the Fight Retinal Blindness! study group have identified a number of variables that predict of sustained loss of visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD).

These include age, active choroidal neovascularisation (CNV) and the number of intravitreal anti-vascular endothelial growth factor (VEGF) injections, they report in Ophthalmology.

Mark Gillies, from The Save Sight Institute in Sydney, New South Wales, Australia, and co-investigators analysed data for 856 eyes in the Fight Retinal Blindness! registry from patients who received anti-VEGF therapy for nAMD between 2007 and 2012.

At baseline, all eyes had a VA above 35 letters, and during 5 years of follow-up 22.9% developed sustained VA loss of at least 15 letters, while 10.8% had a sustained VA loss of at least 30 letters. Sustained VA loss was defined as “at least two consecutive visits where there was loss of ≥15 letters from baseline without recovery of VA”.

The researchers report that eyes with sustained VA loss had poor final VA outcomes. Specifically the mean final VA was 33 letters for the eyes that had a sustained loss of 15 letters or more and 18 letters for those with a sustained loss of 30 letters or more. By comparison, it was 68 for the rest of the cohort who did not have sustained VA loss of at least 15 letters during the study.

After adjustment for baseline age, VA, angiography lesion criteria and lesion size, total number of injections and CNV activity, the team found that patients over 80 years of age had a 33% higher risk of sustained loss of at least 15 letters than younger patients, whilst patients with the most visits (top quartile) at which CNV was graded as active had approximately double the risk versus those with the least visits (bottom quartile).

People who had fewer injections were also more likely to have sustained loss of 15 letters or more, with the risk reduced by 3% with each additional injection.

Gillies et al note that the same variables were associated with increased risk of sustained loss of at least 30 letters, whereas eyes with a baseline VA of 70 letters or higher were a significant 39% less likely to have sustained loss of at least 30 letters than those with a baseline VA below this threshold.

There was no significant association between sustained VA loss and baseline angiographic lesion criteria, however.

Looking into the causes of sustained VA loss, Gillies and co-researchers observed more cases of haemorrhage reducing VA by at least 15 letters (0.27 vs 0.07% of visits) and more retinal pigment epithelium tears (0.05 vs 0.02% of visits) among the eyes with versus without sustained VA loss.

They authors conclude: “Identification of the incidence and predictors of poor outcomes provides more accurate assessment of the potential benefit from anti-VEGF therapy.”

By Laura Cowen

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