Data from: Ten-year survival trends of neovascular age-related macular degeneration at first presentation

Background: To describe 10-year trends in visual outcomes, anatomical outcomes, and treatment burden of patients receiving anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD).

Methods: Retrospective cohort study of treatment-naïve, first-affected eyes with nAMD started on ranibizumab before January 1, 2009. The primary outcome was time to best-corrected visual acuity (BCVA) falling ≤ 35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters after initiating anti-VEGF therapy. Secondary outcomes included time to BCVA reaching ≥ 70 letters; proportion of eyes with BCVA ≥ 70 and ≤ 35 letters at 10 years; mean trend of BCVA and central retinal thickness (CRT) over 10 years; and mean number of injections.

Results: For our cohort of 103 patients, Kaplan-Meier analyses demonstrated median time to BCVA reaching ≤35 and ≥70 letters were 37.8 (95% CI 22.2-65.1) and 8.3 (95% CI 4.8-20.9) months after commencing anti-VEGF therapy, respectively. At the final follow-up, BCVA was ≤35 letters and ≥70 letters in 41.1% and 21%, respectively, in first-affected eyes, whilst this was the case for 5.4% and 48.2%, respectively, in a patient's better-seeing eye. Mean injection number was 37.0 ± 24.2 per eye and 53.6 ± 30.1 at patient-level (63.1% of patients required injections in both eyes). 

Conclusions: The chronicity of nAMD disease and its management highlights the importance of long-term visual prognosis. Our analyses suggest that one in five patients will retain good vision (BCVA ≥70 ETDRS letters) in the first-affected eye at 10 years after starting anti-VEGF treatment; yet one in two patients will have good vision in their better-seeing eye. Moreover, our data suggest that early treatment of nAMD is associated with better visual outcomes.