Antivascular Endothelial Growth Factor Dosing and Expected Acuity Outcome at 1 Year

Kang

et al. 2022

Preprint

BACKGROUND: To evaluate time-dependent changes in injection frequency and visual outcome for the treatment of neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).METHODS: This retrospective study included 667 patients (667 eyes) diagnosed with treatment-naïve neovascular AMD and PCV in 2013 (2013 group), 2015 (2015 group), 2017 (2017 group), and 2019 (2019 group). The number of anti-vascular endothelial growth factor (VEGF) injections and degrees of changes in visual acuity during the first 24 months after diagnosis were compared among the four time groups.RESULTS: During 24 months, the 2013, 2015, 2017, and 2019 groups received means of 5.7 ± 2.7, 6.0 ± 2.8, 6.6 ± 3.0, and 6.9 ± 3.3 injections anti-VEGF injections, respectively. The number of injections was significantly higher in the 2019 group than in the 2013 and 2015 groups (P = 0.003). The mean degree of visual change during the 24 months follow-up period was 0.07 ± 0.55 deterioration in the 2013 group, 0.01 ± 0.51 deterioration in the 2015 group, 0.08 ± 0.50 improvement in the 2017 group, and 0.04 ± 0.48 improvement in the 2019 group. There was a significant difference in the degree of visual changes among the four groups (P = 0.020).CONCLUSION: There was a trend of increasing injection frequency over time and the visual outcome was relatively better in patients diagnosed in the later period. This trend should be considered when predicting the future socioeconomic burden of neovascular AMD and PCV.

Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Real-world Changes in Injection Frequency and Visual Outcomes Over Time in the Treatment of Neovascular Age-related Macular Degeneration

Kang

et al. 2022

Preprint

“…Several studies and treatment guidelines have suggested that proactive treatment strategies such as fixed dosing and treat-and-extend dosing strategies might result in better visual acuity outcomes than PRN dosing when treating patients with nAMD [ 8 , 9 , 10 , 11 , 12 ]. However, a recent systematic review has demonstrated that after adjusting for the number of intravitreal anti-VEGF injections, neither the treatment dosing regimen adopted, nor the anti-VEGF agent used, were significant predictors for visual acuity changes [ 13 ]. Nonetheless, other factors such as age, anatomical status of the retina, including the presence or absence of subretinal and/or intraretinal fluids, optical coherence tomography (OCT) central macular thickness, and macular morphology have been implicated as important prognostic factors in determining visual outcomes [ 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

Lai

Lai²

2021

JPM

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

Current Opinion in Ophthalmology

“…This has been attributed to several factors, particularly differences between real-world and clinical trial patient populations and differences in treatment frequency [ 11 ▪ ]. Notably, several studies, including large real-world studies [ 9 , 10 , 11 ▪ , 12 , 13 ▪ , 14 ] and a recent systematic review [ 15 ▪ ], found that dose frequency is a consistent indicator of vision outcomes, with real-world studies reporting average vision gains of zero to three letters with approximately five to seven injections in the first year of treatment.…”

Section: Introductionmentioning

confidence: 99%

Artificial intelligence-based predictions in neovascular age-related macular degeneration

Ferrara¹,

Newton²,

Lee

2021

Purpose of review Predicting treatment response and optimizing treatment regimen in patients with neovascular age-related macular degeneration (nAMD) remains challenging. Artificial intelligence-based tools have the potential to increase confidence in clinical development of new therapeutics, facilitate individual prognostic predictions, and ultimately inform treatment decisions in clinical practice. Recent findings To date, most advances in applying artificial intelligence to nAMD have focused on facilitating image analysis, particularly for automated segmentation, extraction, and quantification of imaging-based features from optical coherence tomography (OCT) images. No studies in our literature search evaluated whether artificial intelligence could predict the treatment regimen required for an optimal visual response for an individual patient. Challenges identified for developing artificial intelligence-based models for nAMD include the limited number of large datasets with high-quality OCT data, limiting the patient populations included in model development; lack of counterfactual data to inform how individual patients may have fared with an alternative treatment strategy; and absence of OCT data standards, impairing the development of models usable across devices. Summary Artificial intelligence has the potential to enable powerful prognostic tools for a complex nAMD treatment landscape; however, additional work remains before these tools are applicable to informing treatment decisions for nAMD in clinical practice.