Characterizing Progression to Neovascular AMD in Fellow Eyes of Patients Treated With Intravitreal Anti-VEGF Injections

Starr, Matthew R.; Xu, David; Boucher, Nicholas; Saroj, Namrata; Patel, Luv; Ammar, Michael; Pandit, Ravi R.; Jenkins, Thomas L.; Ho, Allen C.

doi:10.3928/23258160-20210302-02

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…The current study was conducted to ascertain whether the nAMD reduction rate persisted at 5 years. While we lacked an internal 5-year control cohort, we believe that our data compared to CATT [ 2 , 28 , 39 ] and other clinical trial [ 31 , 45 , 47 ] results strongly support the protective effect of Zx in preventing nAMD.…”

Section: Discussionmentioning

confidence: 51%

Prevention Surpasses Treatment: 5-year Follow-Up, Cost-Utility, and Cost–Benefit of Zeaxanthin Therapy for Neovascular Age-Related Macular Degeneration

Brown

Gierhart³

et al. 2023

Ophthalmol Ther

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Introduction Oral administration of zeaxanthin (Zx) 20 mg daily in patients with unilateral neovascular age-related macular degeneration (nAMD) treated with triple therapy (photodynamic therapy/intravitreal bevacizumab/intravitreal dexamethasone) reduced fellow-eye 2-year nAMD incidence from 23 to 6% ( p = 0.02) in a prior clinical trial. We questioned the long-term benefit and thus analyzed case–control 5-year patient data of trial participants and additional participants with 5-year follow-up, also performing cost-utility and cost–benefit analyses. Methods Consecutive, unilateral nAMD patient outcomes for those taking 20 mg Zx supplementation orally for ≥ 5 years were compared with the Comparison of AMD Treatments Trials (CATT) 5-year historical controls for fellow-eye nAMD conversion. Eleven-year mean life expectancy, cost-utility and cost–benefit models were undertaken employing a 3% discount rate and 2020 US real dollars. Results Among 227 consecutive patients with nAMD/Zx-supplementation, 202 (90%) had 5-year follow-up. The fellow-eye nAMD 5-year conversion incidence using a Kaplan–Meier cumulative event estimate was 22% (49/227), versus 48% (167/348) with CATT control data ( p < 0.0001). An 11-year cost-utility model with estimates for years 6–11 demonstrated a 0.42 (7.7%) QALY (quality-adjusted life-year) gain, including 3 months of life saved per patient due to decreased nAMD fellow-eye conversion. This yielded a direct ophthalmic medical cost perspective, incremental cost-utility ratio (CUR) of −$576/QALY and a societal cost perspective CUR of −$125,071/QALY. Zx supplementation for all 2020 US unilateral nAMD cases would have theoretically saved society, primarily patients, $6.0 billion over 11 years, a 1531% return on investment (ROI), or 31.3% annual ROI, on Zx costs. Conclusions Oral zeaxanthin supplementation for unilateral nAMD patients appears to decrease fellow-eye long-term incidence and is cost-effective and financially rewarding. It is dominant vs. no supplementation in patients presenting with unilateral nAMD. Trial Registration ClinicalTrials.gov identifier, NCT01527435. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-023-00742-9.

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Section: Discussionmentioning

confidence: 51%

Prevention Surpasses Treatment: 5-year Follow-Up, Cost-Utility, and Cost–Benefit of Zeaxanthin Therapy for Neovascular Age-Related Macular Degeneration

Brown

Gierhart³

et al. 2023

Ophthalmol Ther

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“…Neovascular age-related macular degeneration (nAMD) remains the leading cause of blindness for individuals above the age of 65 in the United States and in many similarly developed countries despite the availability of highly effective therapies targeting vascular endothelial growth factor (VEGF) [ 1 , 2 ]. Most patients initially develop nAMD in one eye with roughly a quarter of at-risk, fellow eyes also going on to develop the disease a few years later [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. The frequent visits required to evaluate and manage unilateral nAMD provide an opportunity to surveil the fellow eyes of these patients for signs of active choroidal neovascularization, most often by means of scanning the macula with optical coherence tomography (OCT).…”

Section: Introductionmentioning

confidence: 99%

Consequences of Real-World Surveillance of Fellow Eyes in Neovascular Age-Related Macular Degeneration

Onwuka

Saddemi

Aydoğmuş

et al. 2023

Life

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This study investigated whether the interval of monitoring at-risk, fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD) has any bearing on the severity of the disease at the time of diagnosis. The study comprised a retrospective, cross-sectional comparative case series of treatment-naïve eyes in patients who were diagnosed sequentially with nAMD. We compared the visual acuity (VA) and central macular thickness (CMT) of patients who were actively receiving intravitreal injections (IVIs) of anti-vascular endothelial growth factor (anti-VEGF) agents at the time of second eye diagnosis with the VA and CMT of patients who had ceased treatment in their first eye because of reaching end-stages of disease. Intervals of visits and frequency of monitoring the macula of fellow eyes by means of optical coherence tomography (OCT) were abstracted from the medical record. We found that the at-risk fellow eyes of patients who had stopped treatment for nAMD in their first eye prior to fellow eye conversion were monitored significantly less frequently than the fellow eyes of patients who continued to receive treatment at the time of second eye diagnosis. Despite less frequent monitoring, VA and CMT were similar at the time of fellow eye diagnosis for both groups.

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“…On the other hand, Daniel et al observed a reduced incidence of symptomatic CNVM in the fellow untreated eye after intravitreal bevacizumab injection in unilateral wet AMD cases [23]. Another study demonstrated that fellow eyes of unilateral wet AMD patients that later converted to wet AMD presented with a better vision and required less injections in the disease course compared to the primary eyes [24]. Therapeutic effects of unilateral intravitreal bevacizumab on the fellow eye in bilateral diabetic macular edema has also been suggested by studies although no signi cant improvement in BCVA was observed [25].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting prognosis and need for anti-vascular endothelial growth factor injections in wet age-related macular degeneration

Kizilay,

Sengun,

Esen

et al. 2023

Preprint

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Purpose: To understand factors affecting visual prognosis and the number of intravitreal antivascular endothelial growth factor (anti-VEGF) injections needed to stabilize wet age-related macular degeneration (AMD). Methods: In this retrospective cohort, 119 treatment-naïve wet AMD patients were followed for two years. In patients with bilateral disease, the eye with worse best-corrected visual acuity (BCVA) or that received more intravitreal injections was recruited as the study eye. In all visits, BCVA was recorded, ophthalmological examination was performed including macular optical coherence tomography imaging. Twenty health status / lifestyle questions were asked to the patients via phone as potential risk factors. All patients received 3 loading doses of intravitreal bevacizumab injections and received repeat injections of aflibercept or ranibizumab when the eye had a new, active neovascular lesion. Results: Patients who took regular micronutrition had similar visual outcome and injection numbers compared to the ones who did not. Patients with bilateral disease needed less intravitreal injections compared to unilateral AMD patients (p=0.016) and women on hormone replacement therapy (HRT) required less injections compared to the women who were not (p=0.024). Female patients had a mean gain of 2.7 letters while male patients lost 3.8 letters (p=0.038). Wet AMD started at an earlier age in smokers (p=0.002). Patients with a better education level presented earlier with better BCVA (p=0.037). Conclusion: HRT and anti-VEGF injections to the fellow eye improved the prognosis of wet AMD, while male patients had slightly worse prognosis. estrogen’s protective effects and potential contribution in wet AMD needs further attention. Retrospectively registered: 2020/0622

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Characterizing Progression to Neovascular AMD in Fellow Eyes of Patients Treated With Intravitreal Anti-VEGF Injections

Cited by 8 publications

References 25 publications

Prevention Surpasses Treatment: 5-year Follow-Up, Cost-Utility, and Cost–Benefit of Zeaxanthin Therapy for Neovascular Age-Related Macular Degeneration

Prevention Surpasses Treatment: 5-year Follow-Up, Cost-Utility, and Cost–Benefit of Zeaxanthin Therapy for Neovascular Age-Related Macular Degeneration

Consequences of Real-World Surveillance of Fellow Eyes in Neovascular Age-Related Macular Degeneration

Factors affecting prognosis and need for anti-vascular endothelial growth factor injections in wet age-related macular degeneration

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