Mark Gillies1, Jennifer Arnold2, Sanjeeb Bhandari3, Rohan W Essex4, Stephanie Young5, David Squirrell6, Vuong Nguyen1, Daniel Barthelmes7. 1. Save Sight Institute, Discipline of Ophthalmology and Eye, Sydney Medical School, University of Sydney Health, Sydney, New South Wales, Australia. 2. Marsden Eye Specialists, Parramatta, New South Wales, Australia. 3. Save Sight Institute, Discipline of Ophthalmology and Eye, Sydney Medical School, University of Sydney Health, Sydney, New South Wales, Australia. Electronic address: sbha5189@uni.sydney.edu.au. 4. Academic Unit of Ophthalmology, Australian National University, Acton, Australian Capital Territory, Australia. 5. Gladesville Eye Specialists, Gladesville, New South Wales, Australia. 6. Department of Ophthalmology, University of Auckland, and Auckland District Health Board, Auckland, New Zealand. 7. Save Sight Institute, Discipline of Ophthalmology and Eye, Sydney Medical School, University of Sydney Health, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Abstract
PURPOSE: To report and compare 10-year treatment outcomes of vascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration (nAMD) from Australia and New Zealand (ANZ) and Switzerland. DESIGN: Retrospective, comparative, interventional case series. METHODS: We analyzed 712 treatment-naive eyes (ANZ, n = 474; Switzerland, n = 321) starting anti-VEGF for nAMD in routine clinical practice between January 1, 2006, and December 31, 2008, tracked in the prospectively designed observational database, the Fight Retinal Blindness! registry. The primary outcome was mean change in visual acuity (VA [in logMAR letters]) in eyes that completed 10 years of treatment. RESULTS: The mean VA in 132 eyes (28%) from ANZ patients who completed 10 years of treatment dropped by 0.9 letters from baseline (95% confidence interval [CI], -4.9 to 3.1; P = 0.7) with 42% achieving ≥20/40, whereas the 37 eyes (12%) from Swiss subjects lost 14.9 letters (95% CI, -24 to -5.7; P < 0.001) with 35% achieving ≥20/40. Eyes from ANZ patients received more injections than eyes from Swiss subjects over 10 years (a median of 53 vs 42, respectively) from fewer visits with better disease control (proportion of visits with active disease: 38% vs 69%, respectively), suggesting a treat-and-extend regimen versus a pro re nata regimen (treatment given only when the lesion is active). Macular atrophy and subretinal fibrosis were the main reasons for 10 letter loss in the subset of eyes analyzed retrospectively. The mean VA of eyes from both regions that discontinued treatment within 10 years had fallen below the baseline at their final visit. CONCLUSIONS: Eyes with nAMD may achieve satisfactory long-term visual outcomes if they receive adequate treatment. Central macular atrophy does not develop universally in eyes receiving long-term treatment with VEGF inhibitors as previously feared. Visual outcomes were better in eyes from ANZ patients, likely because they received more injections.
PURPOSE: To report and compare 10-year treatment outcomes of vascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration (nAMD) from Australia and New Zealand (ANZ) and Switzerland. DESIGN: Retrospective, comparative, interventional case series. METHODS: We analyzed 712 treatment-naive eyes (ANZ, n = 474; Switzerland, n = 321) starting anti-VEGF for nAMD in routine clinical practice between January 1, 2006, and December 31, 2008, tracked in the prospectively designed observational database, the Fight Retinal Blindness! registry. The primary outcome was mean change in visual acuity (VA [in logMAR letters]) in eyes that completed 10 years of treatment. RESULTS: The mean VA in 132 eyes (28%) from ANZ patients who completed 10 years of treatment dropped by 0.9 letters from baseline (95% confidence interval [CI], -4.9 to 3.1; P = 0.7) with 42% achieving ≥20/40, whereas the 37 eyes (12%) from Swiss subjects lost 14.9 letters (95% CI, -24 to -5.7; P < 0.001) with 35% achieving ≥20/40. Eyes from ANZ patients received more injections than eyes from Swiss subjects over 10 years (a median of 53 vs 42, respectively) from fewer visits with better disease control (proportion of visits with active disease: 38% vs 69%, respectively), suggesting a treat-and-extend regimen versus a pro re nata regimen (treatment given only when the lesion is active). Macular atrophy and subretinal fibrosis were the main reasons for 10 letter loss in the subset of eyes analyzed retrospectively. The mean VA of eyes from both regions that discontinued treatment within 10 years had fallen below the baseline at their final visit. CONCLUSIONS: Eyes with nAMD may achieve satisfactory long-term visual outcomes if they receive adequate treatment. Central macular atrophy does not develop universally in eyes receiving long-term treatment with VEGF inhibitors as previously feared. Visual outcomes were better in eyes from ANZ patients, likely because they received more injections.
Authors: Christine A Curcio; Gerald McGwin; Srinivas R Sadda; Zhihong Hu; Mark E Clark; Kenneth R Sloan; Thomas Swain; Jason N Crosson; Cynthia Owsley Journal: BMC Ophthalmol Date: 2020-05-19 Impact factor: 2.209
Authors: Philipp K Roberts; Markus Schranz; Alice Motschi; Sylvia Desissaire; Valentin Hacker; Michael Pircher; Stefan Sacu; Wolf Buehl; Christoph K Hitzenberger; Ursula M Schmidt-Erfurth Journal: Sci Rep Date: 2022-01-07 Impact factor: 4.379
Authors: Vuong Nguyen; Martin Puzo; Jorge Sanchez-Monroy; Pierre-Henry Gabrielle; Catherine C Garcher; Florian Baudin; Benjamin Wolff; Laurent Castelnovo; Guillaume Michel; Louise O'Toole; Daniel Barthelmes; Mark C Gillies Journal: Retina Date: 2021-07-01 Impact factor: 4.256