Delay to treatment and visual outcomes in patients treated with anti-vascular endothelial growth factor for age-related macular degeneration

Abstract

Purpose: To investigate the potential influences that affect visual acuity (VA) outcome in a clinic-based cohort of age-related macular degeneration (AMD) patients undergoing anti-vascular endothelial growth factor (anti-VEGF) treatment for choroidal neovascularization.

Design: Prospective interventional case series.

Methods: Patients with subfoveal choroidal neovascularization (CNV) secondary to AMD were prospectively recruited. A detailed questionnaire was given to patients at time of enrollment, to collect information relating to demographics, history of visual symptoms, visual acuity (VA), and treatment scheduling. Delay from symptoms to treatment ("Treatment delay") was measured in terms of weeks and analyzed in tertiles. Information pertaining to treatment outcomes was collected over a 6-month period.

Results: One hundred eighty-five eyes of 185 patients were recruited into the study. Longer delay from first symptoms suggestive of CNV to first injection was a significant predictor (P=.015) of poorer treatment outcome, when controlling for age, sex, and baseline VA. Patients with a delay in treatment of 21 weeks or more compared to a delay of 7 weeks or less had an odds ratio of 2.62 (1.20, 5.68) for worsening vision after treatment.

Conclusions: Patients experiencing a longer delay between their first symptoms of CNV and their first anti-VEGF treatment have a significantly lower chance of improving vision at 6 months following anti-VEGF therapy. It is critical that this information reach those at potential vision loss from AMD, in order that prompt treatment may be instituted, to maximize the benefits of anti-VEGF treatment.

FIGURE

The predicted probability for change in vision at 6 months based on the timing of anti–vascular endothelial growth factor therapy initiation, from first symptoms of choroidal neovascularization, in eyes with age-related macular degeneration. pr, probability; VA, visual acuity; CNV, choroidal neovascularization; anti-VEGF, anti–vascular endothelial growth factor; Improved, ≥2 lines of improvement in acuity compared to baseline; Stable, within 2 lines of baseline; Worse, ≤2 lines of baseline visual acuity.