Low adherence to anti-VEGF injections results in declining mean visual acuity
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Key takeaways:
- Visual acuity increased by 3 letters on average at year 1.
- By year 6, annual decreases led to a net loss of 4.6 letters.
Adherence to intravitreal anti-VEGF injections may be challenging for some patients with neovascular age-related macular degeneration, putting them at risk for poor vision outcomes, according to research published in Ophthalmology Science.
“This study utilized statistical models to evaluate predictors of [visual acuity] change and assess the impact of baseline characteristics and the number of anti-VEGF injections received on vision outcomes and investigated long-term treatment patterns,” Charles C. Wykoff, MD, PhD, from Retina Consultants of Texas, and colleagues wrote.
In a retrospective, multicenter study, researchers used the IRIS Registry to identify 254,655 eyes from 226,767 patients with neovascular AMD who received intravitreal anti-VEGF injections and had at least 2 years of follow-up. Of those, 160,423 eyes had visual acuity data.
At year 1, researchers reported a mean increase in visual acuity of 3 ETDRS letters, with annual decreases leading to a net loss of 4.6 letters by year 6. Those with longer follow-ups had better visual acuity at baseline and subsequent visits. The mean number of injections plateaued between 4.6 to 4.2 in years 3 to 6, dropping from 7.2 in year 1 and 5.6 in year 2. Further, treatment was discontinued in 38.8% of eyes and switched in 32.3%.
After adjusting for baseline differences, Wykoff and colleagues determined that for each additional injection completed, there was a resulting 0.68 letter improvement between baseline and year 1, indicating that multiple injections may be clinically meaningful.
More than half (58.5%) of participants lost 10 letters or more in visual acuity at least once throughout the follow-up period.
“Overall, these findings suggest that most patients with [neovascular AMD] may find it difficult to adhere to the requirement for frequent intravitreal anti-VEGF injections and could therefore be at risk of experiencing poor vision outcomes,” Wykoff and colleagues wrote. “New therapies, including those with different modes of action and/or new routes of administration, which safely reduce treatment burden by extending the duration between retreatments while maintaining optimal efficacy outcomes, could result in improved visual outcomes for patients in routine clinical practice.”
Perspective
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The most important factors for preserving visual acuity in patients undergoing anti-VEGF injections for wet AMD treatment are consistency and frequency. We should help our patients to expect an injection every 6 months for several years, with individual adjustments by their ophthalmologist. If a patient pauses treatment or delays a part of their series for just 6 months, permanent visual acuity loss is expected.
As patients progress through a several-year course of anti-VEGF injections, the frequency of the procedures generally decreases, so it is vital that patients adhere to their schedule with appropriate follow-ups. Optometrists who care for patients during their anti-VEGF injections should emphasize the importance of long-term, strict compliance.
For patients who have dry forms of AMD, proper education and prompt referrals for anti-VEGF injections at the first signs of neovascularization will help provide their best visual outcomes.
We should help patients understand the value of the anti-VEGF injections and the expected treatment plan and do our best to help them comply. Taking time to compassionately educate patients about their condition and setting proper expectations will help preserve visual acuity and quality of life.
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