Treating nAMD May Worsen Glaucoma Progression in Comorbid Eyes

Inka Pirinen, MD

Neovascular age-related macular degeneration (nAMD) generally coexists with glaucoma in the same eye at a rate similar to that of the 2 diseases among the general population, according to a new retrospective analysis.

In new data from a Finland team of investigators, patient eyes with concomitant nAMD and glaucoma were common enough that clinicians may consider altered strategies to anti-VEGF administration reflective of the need to navigate each chronic eye disease.

Led by Inka Pirinen, MD, of the Tays Eye Center at Tampere University Hospital, investigators sought to evaluate the rate of glaucoma and nAMD requiring anti-VEGF treatment occurring the same patient eyes. They additionally wanted to assess whether progression of glaucoma is more severe or frequent among eyes receiving intravitreal anti-VEGF injections versus those that are not.

“Glaucoma may be more common among patients with neovascular age-related macular degeneration (nAMD) than without nAMD,” investigators wrote. “Although studies on glaucoma progression during anti-VEGF treatment for nAMD give mixed results, repeated anti-VEGF injections have been associated with an increased risk of glaucoma and ocular hypertension.”

Pirinen and colleagues conducted the real-world retrospective data analysis using Tays Eye Center’s patient medical records, consisting of 6314 glaucoma and 2166 nAMD patients treated from 2008 – 2017. They compared changes in visual fields, intraocular pressure (IOP) and fundus photographs to interpret glaucoma progression, comparing such measures in glaucoma eyes with and without anti-VEGF treatment for nAMD. They included ≥1 year of follow-up.

During the decade’s worth of data, investigators observed 147 patients with glaucoma who received intravitreal anti-VEGF treatment for nAMD, corresponding to 2% of glaucoma and 7% of nAMD patients.

Among the 37 eyes with glaucoma and anti-VEGF injections, mean change in visual field—per mean deviation (MD), dB/year—was -0.70, compared to only -0.27 dB/year in 4304 glaucoma eyes without anti-VEGF injections (P = .027).

Investigators additionally observed a greater decline among 20 eyes with bilateral glaucoma treated with anti-VEGF injections (-0.62 dB/year), versus a slight improvement in unilateral nAMD eyes treated with such therapy (0.33 dB/year; P = .654). Glaucoma progression was observed in 14 of 20 fundus photographs in eyes with anti-VEGF treatment, versus 10 of 20 eyes that were untreated.

“Although earlier studies suggest an increased risk of glaucoma in nAMD, the prevalence of glaucoma among nAMD patients treated with anti-VEGF did not differ from the general population in our study,” investigators wrote. “The number of patients receiving medical therapy for glaucoma in Finland has been recently reported to be 7%–8% among 75–79 year olds. That is, similar to our study in which 7% of patients with anti-VEGF-treatment for nAMD were treated for glaucoma.”

Pirinen and colleagues concluded that their findings show nAMD requiring anti-VEGF treatment occurs in combination with glaucoma at a rate similar to the general population—with anticipation that this overlap may increase within the aging global population.

“Fortunately, glaucoma and nAMD requiring repeated intravitreal anti-VEGF injections do not commonly occur in the same patient,” they wrote. “When they do occur concomitantly and obviously nAMD requires active treatment, the impact of IOP spiking on glaucoma progression needs to be carefully considered.”

The study, “Glaucoma progression in patients receiving intravitreal anti-VEGF treatment for neovascular age-related macular degeneration,” was published online in Acta Ophthalmologica.