Long-term outcomes of nationwide coordinated neovascular AMD treatment: A study based on Polish national registry.

PURPOSE: To evaluate long-term outcomes of anti-VEGF therapy for nAMD using the Polish Retinal Therapeutic Program Monitoring Registry.

METHODS: The cohort consisted of 63 840 eyes with nAMD qualified for treatment from 2016 to 2022, with follow-up through 31 October 2023. Long-term follow-up (>5 years) was conducted for 7631 eyes. Statistical comparisons and multivariate logistic regression analysed differences between treatment failure and long-term treatment, treatment effectiveness, drug efficacy and predictive factors.

RESULTS: The relative risk of nAMD in females was 1.45. By the last follow-up, 17 518 (48.6%) patients discontinued treatment due to patient-related factors, 7202 (20.0%) due to treatment failure, 6285 (17.4%) for other reasons and 5065 (14.0%) due to death or clinical complications. Long-term patients were significantly younger, more of them were previously treated, received fewer injections per year and had better baseline BCVA and lower CRT than the failure group. Females and previously treated patients had a higher likelihood of long-term therapy, while older age and initial ranibizumab treatment increased the risk of failure. Patients with an initial BCVA >0.4 logMAR had significantly worse BCVA outcomes, while CRT and treatment strategy showed no significant differences. Introduction of programme exclusion if treatment gap >4 months reduced long breaks, increased injection numbers, slightly lowered BCVA and had no significant effect on CRT.

CONCLUSION: Early visual acuity response, drug choice (aflibercept), and healthcare system modifications influence long-term success and adherence in nAMD management. While systemic changes improved continuity and injection frequency, they did not enhance visual outcomes, highlighting the need for individualized treatment strategies.