Delay to Treatment and Visual Outcomes in Patients Treated With Anti-Vascular Endothelial Growth Factor for Age-Related Macular Degeneration

Abstract

PURPOSE To investigate the potential influences that affect visual acuity (VA) outcome in a clinic-based cohort of age-related macular degeneration (AMD) patients undergoing anti–vascular endothelial growth factor (anti-VEGF) treatment for choroidal neovascularization. DESIGN Prospective interventional case series. METHODS Patients with subfoveal choroidal neovascularization (CNV) secondary to AMD were prospectively recruited. A detailed questionnaire was given to patients at time of enrollment, to collect information relating to demographics, history of visual symptoms, visual acuity (VA), and treatment scheduling. Delay from symptoms to treatment (“Treatment delay”) was measured in terms of weeks and analyzed in tertiles. Information pertaining to treatment outcomes was collected over a 6-month period. RESULTS One hundred eighty-five eyes of 185 patients were recruited into the study. Longer delay from first symptoms suggestive of CNV to first injection was a significant predictor (P = .015) of poorer treatment outcome, when controlling for age, sex, and baseline VA. Patients with a delay in treatment of 21 weeks or more compared to a delay of 7 weeks or less had an odds ratio of 2.62 (1.20, 5.68) for worsening vision after treatment. CONCLUSIONS Patients experiencing a longer delay between their first symptoms of CNV and their first anti-VEGF treatment have a significantly lower chance of improving vision at 6 months following anti-VEGF therapy. It is critical that this information reach those at potential vision loss from AMD, in order that prompt treatment may be instituted, to maximize the benefits of anti-VEGF treatment.

Defining response to anti-VEGF therapies in neovascular AMD

“…The degree of change in VA is contingent on the baseline acuity, that is, at the time-point at which treatment is initiated. 16,[19][20][21] It is intuitive to suppose that treatment given when the disease has not caused permanent destruction of the neural and supporting cells will result in best outcomes. Morphological changes precede the loss of visual function.…”

“…72 Delay in commencing treatment from symptom/disease onset has a detrimental effect on the outcomes of treatment of n-AMD with ranibizumab. 20 Each patient with n-AMD, however, needs to be managed with an individualised treatment plan. This requires follow-up at regular monthly intervals, and treatment as necessary.…”

Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis

“…A recent study by Lim and co-worker showed that delayed intervention leads to insufficient treatment, irreversible macular damage, and a poorer visual outcome. 9 In their study, a delay of 14 weeks doubled the likelihood for the worsening of vision after treatment.…”

Treatment of neovascular age‐related macular degeneration with anti‐VEGF agents: predictive factors of long‐term visual outcomes

“…However, this is difficult to demonstrate because assessment of treatment delay relies on information provided by the patients, who are often uncertain of when the symptoms appeared; additionally, symptom awareness depends on the visual acuity of the fellow eye. This difficulty is even greater in retrospective studies, because treatment delay is frequently not reported by clinicians in a standardized manner [10], as has been shown by our study. Thus, the interval between onset of symptoms and first anti-VEGF injection is usually not analyzed in clinical trials [10] and is not adequately evaluated by retrospective studies.…”

“…This difficulty is even greater in retrospective studies, because treatment delay is frequently not reported by clinicians in a standardized manner [10], as has been shown by our study. Thus, the interval between onset of symptoms and first anti-VEGF injection is usually not analyzed in clinical trials [10] and is not adequately evaluated by retrospective studies. On the other hand, a prospective, clinic-based study, which evaluated visual outcomes after 6 months of anti-VEGF treatment, demonstrated that longer treatment delay from first symptoms of CNV was, in multivariate analysis, a highly significant predictor of adverse visual outcome, by limiting the ability to gain vision with treatment [10].…”