Mean Changes in Visual Acuity Linked to Anti-VEGF Treatment Intensity

David F. Williams, MD, MBA

Patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and vein occlusion-related macular edema showed limited visual outcomes after anti-VEGF therapy for up to 5 years, according to a new retrospective analysis.

The findings suggest patients with nAMD were likely to lose visual acuity at both the 3- and 5-year mark.

David F. Williams, MD, MBA, Retina Consultants of Minnesota and the team of investigators assessed the clinical practice visual acuity outcomes in these patients populations using a retrospective analysis of the Vestrum Health Retina Database.

“Across all 4 disorders, the mean change in VA correlated with treatment intensity at 1, 3, and 5 years,” Williams wrote.

The population consisted of treatment-naive patients with nAMD, DME, branch retinal vein occlusion-related macular edema (BRVO-ME), or central retinal vein occlusion-related macular edema (CRVO-ME) who received anti-VEGF injections between 2014 and 2019 and had follow-up data for ≥12 months. Investigators analyzed data on age, sex, the number of anti-VEGF treatments, and visual acuity.

They identified the primary outcome measure as the mean visual acuity change up to 3 years (BRVO-ME and CRVO-ME) and 5 years (nAMD and DME).

At 1, 3, and 5 years, there were 67,666, 21,305, and 5208 eyes with nAMD, respectively. With each respective population, after a mean of 7.6, 19.5, and 32 injections, there was a mean change of +3.1, –0.2, and –2.2 letters, respectively.

At 1, 3, and 5 years, there were 40,832, 7,728, and 1192 eyes with DME, respectively. After a mean of 6.2, 15.4, and 26.0 injections for each year’s population, there was a mean change of +4.7, +3.3, and +3.1 letters, respectively.

Then, at 1 and 3 years, there were 12,451 and 3,027 eyes with BRVO-ME identified. After a mean of 7.1 and 18.2 injections, there was a mean change of +9.5 and +7.7 letters, respectively.

Moreover, at 1 and 3 years, they identified 9298 and 2264 eyes with CRVO-ME. After a mean of 7.3 and 18.8 injections, there was a mean change of +8.3 and +6.0 letters, respectively (P <.01 for all visual acuity changes of >1 letter.

For all 4 conditions investigated, the mean visual acuity increased with the mean number of anti-VEGF injections, eyes with a baseline visual acuity of 20/40 or better tended to lose visual acuity, and eyes with progressively worse baseline visual acuity saw a progressively greater visual acuity gain at 3 years.

Better visual acuity in patients at baseline was indicated as being more vulnerable to vision loss, according to the study investigators.

The study, “Longer-Term anti-VEGF Therapy Outcomes in Neovascular Age-Related Macular Degeneration, DIabetic Macular Edema, and Vein Occlusion-Related Macular Edema: Clinical Outcomes in 130,247 Eyes,” was published in Ophthalmology Retina.