Long-term outcomes in eyes receiving fixed-interval dosing of anti–vascular endothelial growth factor agents for wet age-related macular degeneration
MC Peden, IJ Suñer, ME Hammer, WS Grizzard - Ophthalmology, 2015 - Elsevier
MC Peden, IJ Suñer, ME Hammer, WS Grizzard
Ophthalmology, 2015•ElsevierPurpose To report on long-term visual outcomes in patients receiving continuous fixed-
interval dosing of anti–vascular endothelial growth factor (VEGF) treatment in neovascular
age-related macular degeneration (AMD). Design Single-practice retrospective chart review.
Participants One hundred nine eyes with exudative AMD receiving continuous fixed-interval
dosing (every 4–8 weeks) of anti-VEGF therapy (ranibizumab, bevacizumab, or aflibercept)
for at least 5 years. Eyes were excluded if they averaged fewer than 6.5 injections per year …
interval dosing of anti–vascular endothelial growth factor (VEGF) treatment in neovascular
age-related macular degeneration (AMD). Design Single-practice retrospective chart review.
Participants One hundred nine eyes with exudative AMD receiving continuous fixed-interval
dosing (every 4–8 weeks) of anti-VEGF therapy (ranibizumab, bevacizumab, or aflibercept)
for at least 5 years. Eyes were excluded if they averaged fewer than 6.5 injections per year …
Purpose
To report on long-term visual outcomes in patients receiving continuous fixed-interval dosing of anti–vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (AMD).
Design
Single-practice retrospective chart review.
Participants
One hundred nine eyes with exudative AMD receiving continuous fixed-interval dosing (every 4–8 weeks) of anti-VEGF therapy (ranibizumab, bevacizumab, or aflibercept) for at least 5 years. Eyes were excluded if they averaged fewer than 6.5 injections per year.
Methods
Snellen visual acuity was recorded at baseline and all subsequent injections. Changes from baseline were calculated at yearly intervals.
Main Outcome Measures
The primary outcome measure was mean change in letter score at 5, 6, and 7 years; secondary outcomes included the percentage of patients with 20/40 vision or better at 7 years and the mean change in letter score at each yearly time point based on baseline visual grouping (20/40 or better, 20/50–20/100, 20/200 or worse).
Results
Forty-four, 75, and 109 patients with 7, 6, and 5 years, respectively, of continuous treatment were identified. Mean change in letter score at year 5 was +14.0 letters (P = 3.9 × 10−9), +12.2 letters at 6 years (P = 1.5 × 10−7), and +12.1 letters at 7 years (P = 3.8 × 10−5). Driving vision (20/40 or better) was achieved in 43.2% of treated eyes. Subanalysis revealed that the greatest visual gains at 5 and 7 years were seen in those patients with baseline visual acuity worse than 20/200 (+24.5 and +25.5 letters), followed by those with 20/50 to 20/100 vision (+6.7 and +6.9 letters), and finally those with 20/20 to 20/40 (+3.7 and +3.4 letters). Patients received an average of 10.5 injections per year.
Conclusions
Continuous fixed-interval dosing of anti-VEGF therapy in patients with exudative AMD results in favorable long-term preservation out to 7 years, with vision stabilizing or improving in 93.2% of eyes. Additionally, 43.2% of patients maintained driving vision in the treatment eye at 7 years compared with 10.1% at baseline. Our data suggest better outcomes with continuous therapy over published results with sporadic, as-needed therapy.
Elsevier