Premium
Predictors of visual outcomes in patients with neovascular age‐related macular degeneration treated with anti‐vascular endothelial growth factor therapy: post hoc analysis of the VIEW studies
Author(s) -
Lanzetta Paolo,
Cruess Alan F.,
Cohen Salomon Y.,
Slakter Jason S.,
Katz Todd,
Sowade Olaf,
Zeitz Oliver,
Ahlers Christiane,
Mitchell Paul
Publication year - 2018
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13751
Subject(s) - ranibizumab , medicine , macular degeneration , aflibercept , ophthalmology , visual acuity , choroidal neovascularization , diabetic retinopathy , post hoc analysis , retinal , retrospective cohort study , bevacizumab , surgery , diabetes mellitus , chemotherapy , endocrinology
Purpose Identify predictors for response to anti‐vascular endothelial growth factor ( VEGF ) therapy in patients with neovascular (wet) age‐related macular degeneration ( nAMD ). Methods Retrospective, post hoc analysis of VIEW 1/2. Patients were randomized 1:1:1:1 to 0.5 mg intravitreal aflibercept ( IVT ‐ AFL ) injection every 4 weeks (0.5q4); 2 mg IVT ‐ AFL every 4 weeks (2q4); 2 mg IVT ‐ AFL every 8 weeks (2q8) after an initial three injections at weeks 0, 4 and 8 or 0.5 mg intravitreal ranibizumab every 4 weeks (0.5q4). Results 1815 patients [ IVT ‐ AFL 2q4 ( n = 613); IVT ‐ AFL 2q8 ( n = 607); ranibizumab 0.5q4 ( n = 595)] were included. Baseline demographics/characteristics were evenly balanced. Younger age (49–69 years), lower visual acuity ( VA ) [10.0–≤45.0 Early Treatment Diabetic Retinopathy Study ( ETDRS ) letters] and smaller choroidal neovascularization ( CNV ) size [0.0–≤3.1 disc areas ( DA )] at baseline were associated with the most vision gain (≥15 letters) over 52 weeks (all nominal p < 0.0001).Younger age, higher baseline VA (>64.0–≤83.0 letters) and smaller CNV size were associated with a VA ≥20/40 at week 52. Predominantly classic CNV at baseline (nominal p = 0.0007), older age (≥90 years), lower baseline VA (10.0–≤ 45.0 ETDRS letters) and larger CNV size (>10.1–≤32.6 DA ) were all associated with a VA ≤20/200 at week 52 (all nominal p < 0.0001). Along with treatment (nominal p < 0.0001), lower VA (p = 0.0166) and smaller central retinal thickness (both nominal p = 0.0190) were predictors for dry retina development. Conclusion Younger age, lower VA and smaller CNV size at baseline were all associated with greater vision gains over 52 weeks while younger age, higher VA and smaller CNV size at treatment start were more likely to achieve best‐corrected VA 20/40 or better after a year's treatment, suggesting the benefit of early anti‐ VEGF treatment.