Consequences of Lapses in Treatment With Vascular Endothelial Growth Factor Inhibitors in Neovascular Age-Related Macular Degeneration in Routine Clinical Practice

Abstract

Purpose: Evaluating outcomes in patients receiving intravitreal antivascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration whom experience a lapse in treatment. Methods: A retrospective chart review evaluating 3,304 patients ≥18 years who experienced treatment lapses ≥3 months compared with control counterparts. Demographic information, macular thickness as measured by central subfield thickness, and visual acuity were collected at baseline, the first postlapse appointment, and at 3, 6, and 12 months after the lapse for the study group. Results: Lapse (n = 241) and control patients (n = 241) had similar baseline visual acuity and central subfield thickness (Early Treatment Diabetic Retinopathy Study: 58.9 ± 20.2 [20/63] vs. 59.2 ± 20.1 [20/63]; central subfield thickness: 252.4 ± 63.2 µm vs. 259.8 ± 66.2 µm, P = 0.21). Analysis revealed that lapse patients experienced a significant increase in central subfield thickness after lapse when compared with controls (279.4 ± 86.9 µm vs. 253.7 ± 65.9 µm, P < 0.01), which normalized on resumption of treatment (259.1 ± 79 µm vs. 246.8 ± 57.6 µm, P = 0.06). Study patients also experienced loss in the visual acuity after lapse when compared with controls (52.9 ± 23.6 Early Treatment Diabetic Retinopathy Study [20/100] vs. 59.9 ± 20.8 [20/63] Early Treatment Diabetic Retinopathy Study, P < 0.01) that did not recover through 12 months of follow-up. Conclusion: Patients with neovascular age-related macular degeneration who have lapses in care are at risk for poorer outcomes. Although macular thickness normalizes on resumption of treatment, their decline in the visual acuity does not recover.

Short-Term Outcomes After COVID-19-Related Treatment Interruption Among Patients with Neovascular Age-Related Macular Degeneration Receiving Intravitreal Bevacizumab

“…Moreover, this study denoted that the time range to determine longlasting damages is brief, with the mean interruption length of 5 ± 3.7 months and a prevalent interruption length of 3-4 months. 23 Our results are in agreement with Stone et al, who reported that eyes with nAMD experienced the greatest loss of vision with treatment delay, and nAMD eyes were less likely to return to baseline on restarting treatment, indeed in this study 74.6% of nAMD patients returned to a BCVA within 5 letters of their baseline. 24 Sekeroglu et al report that visual acuity due to interruption was positively correlated with number of intravitreal anti-VEGF injections at last 6 months before COVID-19 pandemic and central subfoveal thickness at first post-COVID-19 visit; and negatively correlated with follow-up duration.…”

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

“…Guidance to prioritise injections in those with nAMD is based on the known poor outcomes of these patients prior to the advent of anti-VEGF. Multiple studies have shown worsening VA and OCT features in patients who have anti-VEGF injections delayed [ 15 ], with some studies suggesting poor VA persisting on final follow-up despite normalisation of central foveal thickness after a period of delayed treatment [ 16 ]. Our study does support the belief that nAMD eyes do indeed seem to be most at risk of visual loss with delays in anti-VEGF treatment but also shows that RVO eyes have an increased risk from treatment delay.…”

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

“…57 Delays of 3 months or more in antivascular endothelial growth factor (VEGF) treatment were associated with persistently decreased visual acuities in patients with neovascular ARMD, even with resumption of treatment and return to baseline retinal thicknesses. 58 During the initial phases of the pandemic, many patients delayed seeking medical care, even for lifethreatening conditions like myocardial infarctions and cerebrovascular accidents. 59,60 Hospitals and outpatient clinics limited services to concentrate on combating COVID- 19 and decreasing viral transmission.…”