Final visual outcomes worse after anti-VEGF treatment lapse
PHILADELPHIA — Patients with neovascular age-related macular degeneration receiving intravitreal anti-VEGF injections should be encouraged to adhere to their treatment regimen, according to a speaker at the Wills Eye Conference.
“Eyes with neovascular AMD receiving intravitreal anti-VEGF who are lost to follow-up and then return experience significant visual acuity decline at the return visit that persists upon the final visit,” Rebecca Russ Soares, MD, MPH, said.
Building on a study by Obeid and colleagues that demonstrated 22.2% of 9,007 patients did not return for a follow-up anti-VEGF injection for at least 12 months, Soares and colleagues sought to measure visual acuity outcomes in patients lost to follow-up (LTFU).
The study included 93 eyes of 77 patients with neovascular AMD under treatment with anti-VEGF who were LTFU for 6 months or more before returning for an injection. Mean duration of LTFU was 346 days
Visual acuity was documented at the visit before LTFU, at the return visit, at 6 months and 12 months after the return visit, and at the final or most recent visit.
“Over half of patients who returned from that period of lost to follow-up ended up with a median logMAR visual acuity that was worse than their pre-lost to follow-up visit,” Soares said.
At the visit before LTFU, the trend in median visual acuity was 20/80. At the final visit, the trend was 20/200, a statistically significant decrease (P < .001).
The average number of injections before LTFU was 10. After patient return for injections until the final collection of data, the average number of injections was five.
The study suggested some variation in outcomes depending on anti-VEGF agent used, but further exploration with a greater number of patients and documentation of baseline lesion characteristics would be needed to elucidate that point, Soares said.
“The main conclusion to draw ... is the importance of ongoing follow-up in patients with neovascular AMD and the critical need to encourage patients to return,” Soares said. – by Erin T. Welsh
Obeid A, et al. JAMA Ophthalmol. 2018;doi:10.1001/jamaophthalmol.2018.3578.
Soares R. Outcomes of eyes lost to follow-up with neovascular age-related macular degeneration receiving anti-VEGF. Presented at: Wills Eye Conference; March 5-7, 2020; Philadelphia.
Disclosure: Soares reports no relevant disclosures.