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Original Investigation
October 15, 2020

Lifetime Outcomes of Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

Author Affiliations
  • 1Department of Ophthalmology, University of Bonn, Bonn, Germany
  • 2IMBIE, Faculty of Medicine, University of Bonn, Bonn, Germany
  • 3Sydney Medical School, Save Sight Institute, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia
  • 4Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
  • 5Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  • 6Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
JAMA Ophthalmol. Published online October 15, 2020. doi:10.1001/jamaophthalmol.2020.3989
Key Points

Question  What are lifetime outcomes of anti–vascular endothelial growth factor treatment for neovascular age-related macular degeneration?

Findings  In this multistate model using real-world data, an estimated 12% of the sample retained driving visual acuity and 15% reading visual acuity in at least 1 eye over their mean remaining lifetime of 11 years. More injections and younger age at baseline were associated with better outcomes.

Meaning  Good lifetime vision outcomes can be achieved with anti–vascular endothelial growth factor treatment in neovascular age-related macular degeneration with more injections and an earlier start, increasing the chances of good outcomes and highlighting the need to provide easy access to this treatment.

Abstract

Importance  Neovascular age-related macular degeneration (nAMD), the largest single cause of irreversible severe vision loss in high-income countries, can now be treated with vascular endothelial growth factor (VEGF) inhibitors, but to our knowledge, no data on lifetime outcomes are available.

Objective  To determine visual acuity (VA) outcomes of anti-VEGF treatment for nAMD in both eyes for patients’ remaining lifetime.

Design, Setting, and Participants  Multistate modeling using real-world cohort data of 3192 patients with nAMD (>67 000 visits) treated in routine eye clinics in Australia, New Zealand, and Switzerland. Data were analyzed between 2007 and 2015.

Exposures  Intravitreal anti-VEGF treatment at the treating physician’s discretion and prospective data collection in standardized registry.

Main Outcomes and Measures  Visual acuity in both eyes over the remaining lifetime.

Results  For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% CI, 345-400) of the sample retained driving VA and an estimated 15% (n = 463; 95% CI, 434-495) reading VA in at least 1 eye. At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped out. Younger age at baseline and more injections during the first year of treatment were associated with better long-term outcomes.

Conclusions and Relevance  Anti-VEGF treatment was associated with preserved useful visual acuity in almost 20% of patients over their average remaining lifetime. More than 80% of patients will cease treatment over that time, having likely experienced a deterioration of vision beforehand. This is a remarkable outcome compared with outcomes without intervention, which lead to legal blindness within 3 years of disease onset in 80% of those affected. These findings underline the public health necessity of providing anti-VEGF treatment to persons in need.

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