Predictors of Visual Acuity After Treatment of Neovascular Age-Related Macular Degeneration – Current Perspectives

Abstract

Visual acuity is a key outcome measure in the treatment of neovascular age-related macular degeneration (nAMD) using anti-vascular endothelial growth factor agents. Large variations in visual responses between individuals within clinical trials and real-world studies may relate to underlying differences in patient and treatment factors. Most notably, a better baseline visual acuity, younger age and smaller choroidal neovascularization lesion size have been strongly associated with achieving better visual outcomes. In addition, there is emerging evidence for other roles including genetic factors and anatomical variables such as fluid status. Apart from patient-related factors, treatments that favor a higher number of injections tend to provide better visual outcomes. Overall, the identification of predictive factors does not currently play an essential role in the clinical management of patients with nAMD. However, they have allowed for the understanding that early detection, timely management and close monitoring of the disease are required to achieve optimal visual outcomes. Further investigation into predictive factors alongside the development of novel therapeutic agents may one day provide a means to accurately predict patient outcomes. Treatment regimens that offer flexible dosing patterns such as the treat-and-extend strategy currently provide a degree of personalization during treatment.

Efficacy and safety of brolucizumab versus aflibercept in patients with neovascular age-related macular degeneration: a randomized trial in Indian patients

“…Further, anatomical outcomes assessed by OCT, such as CMT changes and the presence of retinal fluid (IRF, SRF, and SHRM), are important indicators of disease activity in nAMD patients [ 14 , 23 ]. In our study, significant improvement was observed in CMT from baseline to week 48 in eyes treated with both the drugs.…”

“…At both time points, the majority of the brolucizumab patients were on a 12-week dosing interval compared to an 8-week dosing interval for aflibercept treated patients. Additionally, it has been shown that individuals with residual SRF at the end of the loading doses may have a negative impact on BCVA gains [ 15 , 23 ]. Our results indicate fewer eyes treated with brolucizumab with SRF presence than aflibercept after the loading doses, i.e., at weeks 8, 12 and 16.…”

“…The SHRM resolution was comparable for both brolucizumab and aflibercept treated eyes. Any retinal fluid presence in the eyes suggests sub-optimal disease control [ 23 , 25 , 26 ]. Thus, improvement in retinal fluid resolution in brolucizumab treated eyes demonstrates an effective anti-VEGF therapy for nAMD Indian patients in clinical practice.…”

“…In addition, brolucizumab has shown effectiveness in improving visual acuity in several studies [13][14][15][16][17][18][19][20]. However, the treatment for nAMD may respond differently in patients at different stages of the disease [21] as well as the treatment may differ in patients with diverse ethnicity and genetic make-up [4,22,23]. Thus, it is imperative to pool the efficacy data of brolucizumab from different populations belonging to various geographical locations and ethnicity.…”

“…The primary endpoint of mean CMT change from week 0 to week 48 was −112.59 ± 81. 23 brolucizumab and aflibercept, respectively with a difference of −26.21 (80% CI, −2.89 to 55.31). At week 12, the same was observed to be −97.34 ± 84.13 µm and −84.34 ± 71.51 µm, respectively.…”