COMMENTARY

Long-term Outcomes of Intravitreal Injections for AMD

Vaidehi S. Dedania, MD; Sophie J. Bakri, MD

Disclosures

June 06, 2014

In This Article

Viewpoint

The findings of this study highlight the progressive nature of exudative AMD and the persistent risk for visual decline and emphasize the continued necessity for anti-VEGF treatment.

Whereas approximately one third of patients had BCVA of ≥ 20/70 and one fourth had BCVA of ≥ 20/40, poor vision was found in approximately one third and legal blindness in 6% of patients, with bilateral exudative AMD in half of all patients. Since exit from the HORIZON study, half of the study eyes had a loss of BCVA of ≥ 5 ETDRS letters with an overall decline in mean BCVA from baseline to the SEVEN-UP assessment. Decline in mean BCVA from baseline may be attributable to less aggressive therapy during the interval between exit from HORIZON and the SEVEN-UP assessment because only 1.6 injections per study eye per year, on average, were administered. This is further supported by the finding of improved visual outcomes in patients receiving ≥ 11 injections in this interval. The strongest association with poor visual outcome was increased area of macular atrophy on FAF. Although OCT is an invaluable tool in the diagnosis and management of exudative AMD, no association was found between visual outcomes and OCT findings in the long-term.

The greatest strength of this study is the duration of follow-up. The cohort of patients in SEVEN-UP had previously received treatment under the ANCHOR, MARINA, and/or HORIZON protocols for a total of 4 years. This cohort represents a study group with the greatest duration of follow-up and the longest period of ranibizumab therapy in patients with exudative AMD thus far.

The limitations of this study include a retrospective component without a standardized interval treatment protocol, the lack of a control group, and the enrollment of a small proportion of patients from the original studies.

The results of the SEVEN-UP trial underscore the importance of continued monitoring and treatment of patients with exudative AMD because patients receiving fewer injections had poorer long-term visual outcomes. Disease quiescence was not attained in most patients; therefore, close clinical surveillance of disease activity and administration of anti-VEGF therapy may be indicated for many years from diagnosis and possibly for life. Findings from the SEVEN-UP study support previous studies showing improved visual outcomes with continued treatment of exudative AMD and the possibility of the persistence of these effects for 7-8 years after treatment initiation.

Abstract

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