Outcomes in Neovascular Age-Related Macular Degeneration with Visit Gaps under Anti-VEGF Therapy in Daily Practice: Data from the Fight Retinal Blindness! Registry.

PURPOSE: To evaluate visual outcomes observed across visit gaps in patients with neovascular age-related macular degeneration (nAMD) treated with anti-VEGF therapy in routine clinical practice.

DESIGN

Retrospective data analysis from a prospectively designed observational outcomes registry: the Fight Retinal Blindness!.

PARTICIPANTS

Treatment-naïve nAMD eyes receiving intravitreal anti-VEGF therapy (≥1 injection), monitored at least quarterly during the first treatment year, and experiencing a visit gap of ≥6 to 12 months, with subsequent follow-up over the next 9 months (≥3 visits).

METHODS

Visual outcomes were assessed using a segmented linear mixed-effect model. Cumulative incidence and risk factors for visit gaps were evaluated using Aalen-Johansen estimators and Cox regression models.

MAIN OUTCOME MEASURES: The main outcome was the mean estimated change in visual acuity (VA) immediately after the visit gap. Secondary outcomes included the cumulative incidence and associated risk factors of visit gaps.

RESULTS

From 3694 eligible eyes for the survival analysis, we tracked 262 (7.1%) eligible eyes experiencing a visit gap for the visual outcome analysis. Neovascular age-related macular degeneration-treated eyes experiencing a 6- to 12-month visit gap had a significant drop in vision immediately after the visit gap, with a mean (95% confidence interval) estimated change in VA of -4.9 letters (-6.0 to -3.7; P < 0.001). Eyes with active choroidal neovascularization (CNV) lesions (difference -3.9 [-7.1 to -0.3] letters vs. inactive CNV) and without subfoveal macular atrophy (MA) (difference 3.4 [-0.3 to 7.0] letters vs. subfoveal MA) at the last visit before the gap experienced a greater decline in VA after the visit gap. A quarter of the eyes experienced a 6- to 12-month visit gap at 6.5 years. Neovascular age-related macular degeneration eyes with a longer time interval since last injection were more likely to experience a visit gap, whereas eyes with better VA and that had active CNV with subretinal fluid only at follow-up visits were less likely.

CONCLUSIONS

Visit gaps were common and associated with a significant visual decline across the visit gap in nAMD eyes treated with anti-VEGF therapy in routine clinical practice.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.