For Some, Anti-VEFG Treatment Preserves Sight for a Lifetime

By Linda Carroll

October 16, 2020

(Reuters Health) - Nearly 20% of those who received anti-VEGF treatment for neovascular age-related macular degeneration (nAMD) retained useful visual acuity over their lifetime, a new study finds.

Using data from more than 3,000 patients and a computer model, researchers estimated that with the treatment 12% would retain the ability to drive and 15% would continue to be able to read with at least one eye until the end of their lives, according to the report published in JAMA Ophthalmology.

"Anti-VEGF treatment preserves useful (visual acuity) in almost 20% of patients for their average remaining life span," Dr. Robert Finger of the University of Bonn and colleagues conclude. "Given the almost uniformly rapid progressive vision loss associated with the natural history of nAMD, this is a remarkable outcome for any chronic disease, underlining the public health necessity of providing anti-VEGF treatment to persons in need as early as possible."

The authors did not respond to a request for comment.

To get a better sense of the long term impact of anti-VEGF treatment on the progression of nAMD, Finger and his colleagues turned to the Fight Retinal Blindness database, a registry that collects data from each clinical visit made by patients with the disease.

The patients in the study resided in Australia, New Zealand or Switzerland, were 55 or older, had received nAMD treatment with anti-VEGF between 2007 and 2015, had visual acuity data for both eyes and at least one follow-up.

The computer model used by the researchers employed three categories of vision impairment that were calculated for both eyes, individually: (1) no vision impairment (visual acuity better than or equal to 20/40); (2) mild vision impairment ( between 20/40 and 20/60); and (3) moderate to severe vision impairment ( visual acuity worse than 20/60).

In their analysis, the researchers used data from 3,192 patients (37% male; most at least 80 years old at baseline) with an eventual total of 67,700 visits. More than a third, 39%, were treated in both eyes. On average, patients were followed for just under three years, during which they received an average of 18 injections.

Patients with good visual acuity in both eyes (vision state 1) had a 13% chance at five years and a 5% chance at 10 years to retain that level of vision in both eyes. They also had a 17% chance of losing vision in one eye and a 13% chance of losing vision in both eyes at five years and an 8% and a 6% chance at 10 years, respectively. Regardless of baseline visual acuity, the rate of transitioning to dropout was 58% to 66% at five years and 84% to 87% at 10 years.

After five years of anti-VEGF treatment, 26% of the sample retained good enough vision in at least one eye to continue driving, while 32% retained reading visual acuity in at least one eye, the model revealed. At that point, 62% of the patients had dropped out. Over the remaining life expectancy, which the researchers estimated to be 11 years, 12% of the patients retained good enough eyesight to continue driving, while 15% still had good enough vision in at least one eye to be able to read.

"This is a great study," said Dr. Avnish Deobhakta, an assistant professor at the Icahn School of Medicine at Mount Sinai and a retinal surgeon at the New York Eye and Ear Infirmary of Mount Sinai in New York.

Without treatment, most patients are blind within three years, he noted.

"The big thing is we do have a treatment for AMD," Dr. Deobhakta said. "The problem is getting patients in for it. It can be tough for elderly patients to get to the hospital, so many don't get the treatments they need. The charts in the study show that among patients diagnosed with AMD, 40% received less than five treatments in the first year."

The medication blocks a molecule that tells the eye to grow new blood vessels under the retina, Dr. Deobhakta said. Those blood vessels cause problems because they can leak, he explained.

"If you catch the disease early enough and give the injections on a consistent basis, the vessels will stop leaking and may even regress," Dr. Deobhakta said. "And then the retina can be healthy again. That is an incredible paradigm shift."

SOURCE: JAMA Ophthalmology, online October 15, 2020.