ASRS 2026: Nearly 40% of patients with wet AMD go untreated for 180 days within the first year

Real-world non-persistence rises steadily over time

At the 44th Annual Scientific Meeting of the American Society of Retina Specialists (ASRS 2026) in Montreal, Canada, Andrew Moshfeghi, MD, MBA, presented real-world data on anti-VEGF treatment patterns in neovascular age-related macular degeneration (nAMD). The retrospective analysis drew on the Vestrum Health database, examining 201,766 eyes from 158,727 treatment-naive patients who initiated anti-VEGF therapy between 2015 and 2024, with follow-up of up to 9 years.

Nearly 40% of patients non-persistent within 1 year

Cumulative incidence of non-persistence—defined as no injection for more than 180 days after the previous injection—reached 38.9% at year 1 and climbed to 84.6% by year 9. Among eyes that remained on therapy, injection frequency peaked at a mean of 8.4 injections per year in year 1 before declining to a range of 6.0 to 6.6 injections per year in years 2 through 9. Poor visual acuity (VA) outcomes and treatment burden were both associated with non-persistence (P <.001).

Continued treatment linked to better, though still declining, vision

Eyes that stayed on therapy gained a mean of 3.9 letters at year 1 but lost 9.9 letters cumulatively from year 1 to year 9. Non-persistent eyes fared worse, with poorer VA improvement in the first year and faster decline in subsequent years. Delayed treatment initiation was associated with poor VA outcomes, and a higher number of injections was associated with greater VA gains at year 1 (P <.001).

Barriers to adherence are largely logistical

Moshfeghi said the treatment gaps identified in the data reflect logistical barriers rather than under-prescribing. Many nAMD patients are elderly and no longer drive, requiring a caregiver to transport them to appointments that can last 2 to 3 hours. "It's one thing to have someone, you know, take you to an appointment, and then 15 minutes later you're on your way out," Moshfeghi said. "But that's not the case. You have to have someone who can bring you, stay with you the whole time, and then leave with you."

Longer-acting therapies could ease the burden

Moshfeghi noted that newer anti-VEGF agents dosed less frequently could reduce the clinical impact of missed visits, since the drugs may continue exerting a therapeutic effect even if a patient's follow-up is delayed. He said he expects additional long-acting options to reach clinical practice within the next 12 to 24 months.