Prognostic factors aid selection of anti-VEGF therapy candidates, treatment schedule

PARIS — Retrospective analysis of potential prognostic factors may help clinicians understand which patients with age-related macular degeneration are likely to respond well to anti-VEGF therapy, a speaker said here.

"Anti-VEGF treatment has changed dramatically the prognosis of AMD. In most cases, visual acuity will not decrease any further, and in about 20% of the patients, vision will even increase. A substantial number of patients will still be able to read books and drive their car," Frank D. Verbraak, MD, said at the Euretina meeting.

However, not all patients experience an improvement, and there is currently no way of predicting which patients will respond well and which will deteriorate despite treatment.

In a retrospective study, potential prognostic factors were evaluated, including baseline best corrected visual acuity, type and size of choroidal neovascularization evaluated by fluorescein angiography, central retinal thickness, amount of subretinal fluid, and other retinal conditions detectable on optical coherence tomography. Response to the 3 monthly injections of the loading phase was also evaluated.

"We found that the best prognostic factor is the response to the first three treatments. Patients with improved BCVA and absent signs of leakage at the time of the third injection had the greatest improvement in [visual acuity], the largest decrease in retinal thickness and needed less re-treatment," Dr. Verbraak said.

"Final outcome was negatively related to larger amounts of subretinal fluid, presence of cystoid changes in the retina, larger size of the lesion, larger presence of fibrovascular pigment epithelium detachment, [and] absence of the [inner segment/outer segment] transition," he said.