Anti-VEGF therapy did not prevent conversion to neovascular AMD in fellow eyes
The use of intravitreal anti-VEGF injections did not prevent conversion from nonexudative to exudative age-related macular degeneration in the fellow eyes of patients with unilateral neovascular AMD.
“Exactly the same number of patients treated with ranibizumab or sham developed conversion within 2 years,” Clement K. Chan, MD, FACS, said at the virtual American Academy of Ophthalmology annual meeting.
It is known that patients with unilateral neovascular AMD have a significant risk for progression to neovascular disease in the fellow eye. In the MARINA, ANCHOR, SST and CATT trials, conversion rate over 2 years was in the range of 17% to 35%. Because bilateral AMD is a major cause of legal blindness, “preventing AMD in the fellow eye has major public health implications,” according to Chan.
“The AREDS1 and AREDS2 studies showed that supplements can retard the progression of AMD, but there is a dearth of knowledge of the best option for managing fellow eyes with features of nonexudative AMD,” he said.
The PREVENT study investigated whether progression to neovascular AMD could be prevented by treating the fellow eyes with anti-VEGF injections when they presented signs of nonexudative AMD at a high risk to convert to the exudative form, such as multiple intermediate drusen or at least one large drusen and pigmentary changes.
The multicenter, prospective, randomized study included 108 patients with neovascular AMD, randomly assigned 1:1 to receive 0.5 mg ranibizumab injection vs. sham every 3 months in the fellow eye with the nonexudative form over a study time of 24 months. Ninety-one patients completed the study, and 14 (13%) of them developed conversion, seven in each of the ranibizumab and sham groups.
“Our results were similar to those of other studies, such as the PROCON, where aflibercept was used vs. sham and where 13% of treated eyes and 16% of sham eyes converted within 2 years,” Chan said.
He said that intravitreal injections do not seem to reduce the conversion rate. However, he did not exclude that a more robust anti-VEGF regimen might have a more significant effect.
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Chan CK, et al. First-time trial data - the PREVENT trial. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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