Manjot Gill, MD: Baseline Characteristics, Visual Outcomes with Anti-VEGFs

A study presented at the 2019 American Society of Retina Specialists Annual Meeting is highlighting the importance of early action when a patient is diagnosed with neovascular age-related macular degeneration.

The study, which was presented by Manjot Gill, MD, associate professor of Ophthalmology at the Feinberg School of Medicine, found that early diagnosis and treatment could help save a patient’s vision.

In an effort to better understand the outcomes of anti-VEGF treatments in nAMD eyes with varying levels of vision, investigators conducted a retrospective cohort study of patients with treatment-naïve eyes treated with bevacizumab, ranibizumab, or aflibercept by 4 physician investigators from a tertiary center from March 2008 to Oct. 2015. Final outcomes of the study were final visual acuity, change in visual acuity, number of injections, and number of treatment days.

Investigators defined eyes with good initial visual acuity as 20/50 or better, intermediate as 20/200 to 20/50, and poor as 20/200 or worse. A total of 224 eyes were evaluated in the study. Investigators characterized 78 as having good initial visual acuity, 86 as having intermediate visual acuity, and 60 as having poor visual acuity. 

Upon analyses, investigators found 71.8% of eyes with good initial visual acuity had a final visual acuity of 20/50 or better versus 40.7% of those with intermediate, and just 16.7% of those with poor visual acuity at baseline.

Among eyes with good baseline visual acuity, 14.1% increased 2 or more lines of vision on LogMAR. This number was much higher among the intermediate (37.2%) and the poor (58.3%) visual acuity groups.



To expand on the implications of the study, Gill sat down with MD Magazine® at ASRS 2019 to give her thoughts.

MD Mag: Can you describe the results of your study into baseline characteristics and visual outcomes?

Gill: So, our study was really looking at the outcomes of treatment of patients with wet macular degeneration with anti-VEGF therapy and what we found was that patients who initially presented with good initial baseline visual acuity tended to do the best in terms of their final visual outcome.

So, really what this means for the primary care physician is that if they know of patients in their practice who have macular degeneration to really counsel them to look for changes in their vision and the moment that a patient detects or feels that their vision may be declining that would be the time to make a referral to a general ophthalmologist or to a retina specialist — because really the take-home was that the earlier that we can diagnose wet macular degeneration and confirm the diagnosis and institute treatment, the more likely we are to hold on to the patient's vision and that was what was shown through the course of the long-term follow-up of our study.

So, the patients with good initial visual acuity didn't gain as much vision because they entered at a point where they had good baseline vision, but the good news is that those patients were able to hold on to that vision and end up with final better visual outcomes. On the other hand, patients who had poor vision going in tended to gain more vision, but at the end of the day they actually still had poor final visual acuity levels compared to those who initially had good vision. So, that, again, just reiterates the importance of early detection and treatment of patients with macular degeneration.