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Study Identifies Predictive Factors for Efficacy of Anti-VEGF Injections

The only factor that predicted visual outcomes one year after nAMD diagnosis was baseline visual acuity, which maintained its predictive ability five years after diagnosis. Visual acuity increased more frequently in women.

To identify factors that predict long-term visual outcomes of treatment with anti-vascular endothelial growth factor (VEGF) agents in patients with neovascular age-related macular degeneration (nAMD), a team of researchers retrospectively reviewed the records of 117 of these patients treated at the Centro Hospitalar Sao Joao in Porto, Portugal.

The researchers assessed visual outcomes 12 and 60 months after diagnosis of nAMD. These outcomes included:

  • Visual acuity
  • Visual acuity ≥65 letters on the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart
  • Variation in visual acuity >0 letters on the ETDRS chart

They analyzed whether the following baseline variables could predict visual outcomes after anti-VEGF treatment:

  • Age
  • Central foveal thickness
  • Sex
  • Subfoveal hemorrhage or fibrosis
  • Subtype of choroidal neovascularization
  • Visual acuity
  • Whether treatment was delayed

In addition, they analyzed the predictive value of the following variables during follow-up:

  • Frequency of medical examinations
  • Number of missed medical examinations
  • Number of intravitreal injections
  • Number of missed intravitreal injections
  • Suspension of treatment
  • Retinal atrophy
  • Subretinal fibrosis
  • Sudden massive retinal hemorrhage
  • Torn retinal pigment epithelium

As a result, the researchers found that the only factor that predicted visual outcomes 12 months after diagnosis was baseline visual acuity. Greater baseline visual acuity was associated with greater final visual acuity and a greater chance of having a final visual acuity ≥65 letters on the ETDRS chart. Greater baseline visual acuity was also associated with less variation in visual acuity and less chance of an increase in visual acuity.

Baseline visual acuity still predicted all visual outcomes 60 months after diagnosis of nAMD. However, more injections and the absence of subretinal fibrosis during follow-up also predicted greater final visual acuity 60 months after diagnosis.

The researchers also found that visual acuity increased more frequently in younger patients and in women.

These findings led them to conclude that baseline visual acuity affects absolute visual acuity and variation in visual acuity 12 and 60 months after diagnosis of nAMD. In addition, they concluded that the number of injections given, the development of subretinal fibrosis, age at diagnosis, and sex predicted visual outcomes of anti-VEGF treatment 60 months after diagnosis.

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