Second eyes to develop neovascular age-related macular degeneration have fewer symptoms and better one-year visual outcomes

Abstract

Background This study compares the visual and anatomical outcomes for the eyes of patients who developed sequential neovascular age-related macular degeneration (nAMD), both at the time of diagnosis and at one year after treatment. Methods The study comprised a retrospective case series of 52 patients whose eyes were diagnosed sequentially with nAMD. All eyes were treated with three monthly loading doses of anti-vascular endothelial growth factor agents, followed by further intravitreal injections, as required. Baseline characteristics and outcomes at one year after diagnosis and initial treatment were compared between first and second eyes and included visual acuity (VA), central macular thickness (CMT), and pigment epithelial detachment (PED) height on optical coherence tomography (OCT) imaging. Results VA at diagnosis was better for second eyes compared with first eyes to develop nAMD (logMAR 0.68 ± 0.51 versus logMAR 0.41 ± 0.34, P = 0.002) and remained so at one year (logMAR 0.61 ± 0.60 versus logMAR 0.42 ± 0.37, P = 0.041). Similarly, PED height at diagnosis was higher in first eyes (225 ± 176 μm versus 155 ± 144 μm, P = 0.003) and also at one year (188 ± 137 μm versus 140 ± 112 μm, P = 0.019). Whereas most patients reported symptoms at first eye diagnosis (71.2%), half as many second eyes were symptomatic (28.8%, P < 0.001). Significantly more symptomatic first eyes experienced visual distortions (32.4% versus 13.3%) or scotomas (29.4% versus 6.7%), compared with a less specific visual complaint of blurry vision (38.2% versus 80.0%, P = 0.006). Conclusions Compared with first eyes to develop nAMD, second eyes tended to have better vision, smaller PED heights, and fewer symptoms likely because monitoring permitted earlier diagnosis.

Patient adherence to therapy after switch to aflibercept from bevacizumab or ranibizumab for treatment-refractory neovascular age-related macular degeneration

“…[ 17 ] When aflibercept and bevacizumab were initially compared, strict clinical trial protocols were in place to optimize patient compliance with treatment, including receiving the help of study coordinators, study-provided medications, and other incentives for participation. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ] However, patients undergoing treatment for nAMD must contend with real physical,[ 20 21 ] psychological,[ 6 20 22 ] and financial[ 23 24 ] burdens associated with treatment. These burdens can often influence a patient's ability to comply with recommended treatment protocols.…”

“…All eyes were treated with an initial set of three-monthly loading doses of IVB or IVR, in accordance with a treat-and-extend protocol designed to sustain a fluid-free macula, as previously described. [ 13 ] Patients were switched to IVA when refractory to initial treatment, defined by the inability to attain or maintain a 28-day fluid-free period between treatments. Patients with other retinal conditions were excluded from the study (e.g.…”