Ten-year real-world outcomes of anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration

Abstract

Background: Neovascular age-related macular degeneration (nAMD) has been treated with anti-vascular endothelial growth factor (anti-VEGF) therapy since 2006 with initial efficacy evidence of 2 years. In many, long-term therapy is required, and evidence for benefit is required from real-world data collection. Methods: Retrospective review of electronic medical records of a consecutive series of patients treated with anti-VEGF therapy for nAMD over a 10-year period. Age, lens status and loss to follow-up was recorded. Primary outcome was change in VA at 10 years; secondary outcomes included proportion of eyes losing <15 letters at 3, 5, 7 and 10 years, number of injections and anatomic outcome. Results: Of 196 patients (197 eyes), 90 patients had 10 years of follow-up data. Visual acuity (VA) declined by −11.2 letters (p=0.001), but 63.3% of eyes lost ≤15 letters. The proportion of eyes maintaining ≥70 letters was 17.7%, and the mean number of injections (±SD) was 47 ± 16. Retinal fluid was still present in 72.2% of eyes at 10 years. Forty-six percent of patients continued to receive anti-VEGF injections 10 years after treatment was commenced. Conclusion: Anti-VEGF treatment for nAMD over a ten-year period showed 63.3% of eyes lost ≤15 letters. Eyes with better baseline vision were more likely to continue receiving antiVEGF treatment, but the frequency of injection treatment decreased.