Baseline predictors for good long-term visual outcomes in the treatment of neovascular AMD with intravitreal anti-VEGF therapy.

Abstract

Abstract Purpose To determine factors predictive of good visual acuity (VA) 4 or more years following the initiation of treat and extend (TER) anti-VEGF therapy for neovascular AMD. Methods 266 eyes of 232 patients who initiated a TER of intravitreal anti-VEGF therapy by a single physician from January 2006-January 2013 and had the following inclusion criteria: age >=50 years, VA >= 20/60 at 4 year follow-up, and absence of permanent foveal structural damage, were evaluated. Neovascular lesions were classified using fluorescein angiography (FA) alone as well as using FA+optical coherence tomography (OCT). Correlation of long-term good VA with lesion subtype and VA at baseline, 3 months and final 4 year follow-up, was performed. Results Of the original 266 eyes, 78 patients (84 eyes) had 4 years of follow-up. Of these, 43 patients (44 eyes) (47.7% male) fit the inclusion criteria and retained VA>=20/60 (Mean 20/40). The mean age at baseline was 78.48+/-7.8 years, and the mean number of injections at 4 year follow-up was 32.30+/-5.8 (range: 13-41). Using FA alone, 43.2% of baseline lesions were occult, 18.2% were classic CNV, 25% were retinal angiomatous proliferation (RAP), and 13.6% were mixed. Using FA+OCT, 47.7% of baseline lesions were type 1 (sub-RPE), 9.1% were type 2 (sub-retinal), 25% were type 3 (intra-retinal), and 18.2% were mixed. Significant positive correlations were found between VA at baseline and at 3 months (r=0.676, p<0.001), as well as between VA at 3 months and 4 years (r=0.350, p=0.021). A positive trend was detected between VA at baseline and the final 4 year VA. Lesion area (p=0.033) and diameter (p=0.031) were associated with good VA at final 4 year follow-up. Conclusions Visual acuity at 3 months appears more predictive of good long-term VA than initial VA. Baseline lesion size (area and diameter) was more predictive of good long-term VA than initial lesion composition.