Author: Elisa Cornish
Co-authors: Vuong Nguyen, Martin Puzo, Louise O’ Toole, Chui Ming Gemmy Cheung, Andrea Vincent, Tremeur Guillaumie, Sioe Lan Oei, Helena Brosa Morros, Daniel Barthelmes
Abstract
Purpose: We assessed the outcomes of eyes with neovascular age-related macular degeneration (nAMD) that switched from a proactive to a reactive treatment regimen after developing physician-graded, center-affecting macular atrophy (MA) or submacular fibrosis (SMFi).Setting: Data were collected from a prospectively designed, multinational registry of “real-world” nAMD treatment outcomes from 2006 to 2021.
Methods: Eyes without MA or SMFi when they started treatment with a proactive vascular endothelial growth factor inhibitor regimen that subsequently developed centre-affecting MA or SMFi were included. Reactive treatment regimens were classified as either “fluid tolerant” or “fluid-intolerant “
Results: Center-affecting MA developed in 821 eyes that did not have it initially while 1166 eyes developed centre-affecting SMFi. Seven percent of eyes that developed central MA, and 9% of those that developed central SMFI, were switched to reactive treatment, perhaps in view of the likely progressive decline in vision despite ongoing regular injections. Mean (95% CI) VA change 12 months later, the primary outcome, was generally stable for all eyes with MA (0 [-3, 3] and -1.4 [-3, 0.2] letters for fluid tolerant and fluid intolerant, respectively) and eyes with SMFi and inactive lesions (-0.8 [-2, 0.4] letters). Eyes that switched to reactive treatment after developing central SMFi when the lesion was active, however, had significant loss of vision (-3.6 [-6, -1.2]; P = 0.004). No eyes that continued proactive treatment developed a ≥15 letter loss over 12 months, but this was found in 8% of all eyes that switched to a reactive regimen, increasing to 15% of those with active lesions that switched after developing central SMFi.
Conclusion: Eyes that switch from proactive to reactive treatment after developing center- involving MA, and inactive center-involving SMFi, can have stable visual outcomes. Physicians and patients should be aware, however, of an increased risk of a significant loss of vision that was not seen in eyes that continued proactive treatment, particularly in eyes that switched after developing SMFi when they were active.
Financial Disclosures: This study was supported by unrestricted research grants from Bayer and Novartis.
