Early diagnosis, additional anti-VEGF injections may improve outcomes in neovascular AMD
Early detection and an increased number of anti-VEGF injections, as well as accurate fluid resolution targeting during treatment induction, may improve visual outcomes for patients with neovascular age-related macular degeneration, according to a study.
“Anti-VEGF therapies have revolutionized the treatment of nAMD [neovascular AMD]. Their efficacy in the maintenance of patient’s visual acuity, owing to their mode of action in keeping the macula dry by inhibiting the recurrence of fluid, has been demonstrated in many pivotal trials,” Giovanni Staurenghi, MD, professor of ophthalmology at the University of Milan in Italy, and colleagues wrote in PLOS One. “Early detection, diagnosis, prompt therapeutic intervention and continuous follow-up to assess fluid accumulation and other activity signs are critical to prevent irreversible vision loss; nonetheless, these are difficult to achieve in clinical practice, thus creating a gap between clinical trial and real-world results.”
Staurenghi and colleagues conducted a 2-year, retrospective cohort study to assess the overall effectiveness of anti-VEGF therapy in treatment-naive patients with nAMD in a clinical practice setting. The primary objective of the study was to evaluate the mean annualized number of anti-VEGF injections at years 1 and 2, and key secondary objectives were to evaluate the mean change in visual acuity from baseline and analyze the variables associated with visual outcomes at years 1 and 2.
Of 745 patients (mean age, 75.6 years) who received their first dose of anti-VEGF, 429 (57.05%) and 335 (44.5%) patients completed the 1- and 2-year follow-ups, respectively. The mean visual acuity was 53.43 letters at baseline. There was a mean number of 8.2 injections performed over the 2 years, resulting in a mean change in visual acuity at years 1 and 2 of 2.45 (P = 0.0005) and 1.34 (P = 0.3984) letters, respectively.
Age, baseline visual acuity, number of injections and early fluid resolution were independently associated with visual outcomes at years 1 and 2.
“More effective therapies targeting retinal fluid along with individualized proactive treatment strategies and stricter follow-ups are needed to achieve appropriate patient treatment in terms of efficacy, despite the limited treatment capability of the Italian health care system,” the researchers concluded.
Perspective
Back to Top
Early detection of a choroidal neovascular membrane is needed to provide our patients with the best post-injection visual outcome. A few ways this can be achieved include increased use of OCT, more frequent follow-up visits and improved patient education. Early detection is especially important in patients with good visual acuity.
Patients with a better baseline visual acuity who received a higher number of anti-VEGF injections achieved better visual results. The visual acuity at 1 year after starting anti-VEGF treatment was significantly improved from baseline, but little additional change occurred during the second year of treatment. Treatments delivered during year 2 were, however, responsible for maintaining the year 1 acuity gains. This highlights the necessity of maintaining follow-up appointments, as the first-year visual improvement can be wasted if the patient is lost to follow-up in year 2.
Our patient education ought to include a candid conversation with our patients and their families regarding the necessity for strict follow-up care with our retinal specialist colleagues. If we communicate the importance of year 2, “the maintenance year,” before we refer for injections, the patient may be less likely to be lost to follow-up.
Some of the inherent limitations in this retrospective study include lack of standardization with both OCT and retreatment protocols. Nonetheless, we can use this data to focus on making earlier diagnoses and improved patient education.
Collapse
Read more about