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Purpose: To evaluate the clinical course of patients with neovascular age-related macular degeneration (AMD) who experienced severe visual deterioration despite initially good visual acuity. Methods: This retrospective observational study included patients diagnosed with wet AMD and treated with anti-vascular endothelial growth factor. Only patients whose initial best-corrected visual acuity (BCVA) was 0.5 or better but deteriorated to 0.1 or worse at the final visit were included. Patients were classified into three groups and analyzed; patients who experienced development of submacular hemorrhage (SMH) during the follow-up period were classified as SMH, patients who were lost to follow-up but then revisited were classified as lost to follow-up, and remaining patients were classified as remaining. Results: Fifty-five eyes of 55 patients were included in the study. The mean follow-up period was 43.5 ± 9.4 months. In the SMH group (n = 28), the mean logarithm of minimal angle of resolution (logMAR) BCVA was 0.46 ± 0.25 before SMH, 1.10 ± 0.30 at SMH onset, and 1.37 ± 0.46 at final follow-up. In the lost to follow-up group (n = 14), the mean BCVA was 0.33 ± 0.16 before follow-up loss, 1.33 ± 0.36 at the revisit, and 1.36 ± 0.46 at final follow-up. In the remaining group, mean BCVA was 0.24 ± 0.09 at diagnosis and 1.40 ± 0.37 at final follow-up. Conclusions: Marked visual deterioration after SMH and loss to follow-up may be causes of severe visual loss in patients with neovascular AMD who initially showed good visual acuity.

journal of retina

Clinical Course of Patients with Neovascular Age-related Macular Degeneration Who Experienced Visual Deterioration after Treatment despite Initially Good Visual Acuity