Impact of treating AMD before visual function is impaired

While the advent of anti-VEGF therapies resulted in substantially better outcomes in this patient population, the results can vary substantially among patients.

Japanese investigators led by first authors Risa Aichi, MD, and Norihiro Nagai, MD, reported that before the best-corrected visual acuity (BCVA) decreases and advanced lesions develop in eyes with age-related macular degeneration (AMD) is the optimal time to begin treatment with anti-vascular endothelial growth factor (VEGF) therapy to obtain better outcomes in the real-world clinic. 

Aichi and Nagai are respectively from the Department of Ophthalmology, St. Luke’s International Hospital, and Department of Ophthalmology, Keio University School of Medicine, both in Tokyo, Japan.

While the advent of anti-VEGF therapies resulted in substantially better outcomes in this patient population, the results can vary substantially among patients.

“Evaluating the treatment outcomes and factors associated with a good prognosis may help clinicians improve their treatment plans,” the investigators explained.

They retrospectively reviewed the medical charts of 104 eyes (104 patients) with AMD that had been treated with anti-VEGF drugs and followed for a minimum of 1 year out to 3 years. All patients had received anti-VEGF treatment as the first therapy for AMD.

Positive and negative predictors identified

Analysis showed that an initial BCVA < 0.3 logarithm of the minimum angle of resolution (logMAR) was a positive predictor (odds ratio [OR], 3.172; 95% confidence interval [CI], 1.029–9.783; p = 0.045), and the presence of initial fibrovascular pigment epithelial detachment (PED) was a negative predictor (OR, 0.222; CI, 0.078–0.637; p = 0.005) of maintained or improved BCVA at the final visit, the authors reported.

Further, the analysis showed that eyes with an initial BCVA < 0.3 (Cox hazard ratio, 2.947; 95% CI = 1.047–8.289; p = 0.041) had a better survival rate after adjusting for age when failure was defined as a BCVA reduction of ≥ 0.2 logMAR VA.

Patients who had an initial BCVA < 0.3 were younger, more often had subretinal fluid as an exudative change, and less frequently had intraretinal fluid, submacular hemorrhage, and fibrovascular PED.

“These results may help elucidate points requiring attention when examining eyes with AMD and the timing for offering treatment to this patient population in real-world settings,” the investigators concluded. “They may also emphasize the importance of advising individuals to visit the eye clinic when they observe even minor symptoms and clinicians to detect AMD lesions at the early stage.”

Reference

Aichi R, Nagai N, Ohkoshi K, Ozawa Y. Impact of treating age-related macular degeneration before visual function is impaired. J Clin Med. 2022,11: 5726; doi:10.3390/jcm11195726