Ophthalmology. Retina · 2025
Characteristics and Outcomes of Patients with Neovascular Age-Related Macular Degeneration by Anti-VEGF Exposure in United States Clinical Practice.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Barikian Anita, Kumar Jaya B, McCullough April J, Silva Fabiana Q, Sherman Steven, Tanenbaum Kathryn, Moini Hadi, Singh Rishi P
Аннотация
OBJECTIVE: To assess 1-year visual outcomes of patients in routine clinical practice treated with ≥7 anti-VEGF injections for neovascular age-related macular degeneration (nAMD), baseline characteristics associated with receiving ≥7 anti-VEGF injections, and impact of treatment exposure on visual outcomes.
DESIGN: Retrospective analysis.
PARTICIPANTS: Treatment-naive eyes with baseline best-corrected visual acuity (BCVA) ≥20/400, from patients aged ≥55 years with nAMD diagnosed from January 1, 2013 to December 31, 2019.
METHODS: This analysis included eyes from the American Academy of Ophthalmology IRIS Registry® (Intelligent Research in Sight). Visual outcomes were evaluated by treatment exposure (≥7 or <7 intravitreal anti-VEGF injections) through year 1. Baseline factors associated with ≥7 anti-VEGF injections and impact of treatment exposure on visual outcomes were evaluated by logistic regression.
MAIN OUTCOME MEASURES: Best-corrected visual acuity change from baseline by treatment exposure, association between baseline factors and treatment exposure, and magnitude of BCVA change by baseline factors and treatment exposure at year 1.
RESULTS: Of 295 561 eligible eyes, 184 258 actively treated were analyzed (≥7 anti-VEGF injections: 109 696 eyes [59.5%]; <7 injections: 74 562 eyes [40.5%]). At year 1, eyes receiving ≥7 injections achieved greater BCVA gains versus those receiving <7 injections (least squares mean change [95% confidence interval]: +3.4 [3.3-3.5] vs. -0.2 [-0.3 to 0.0] letters). Asian or Black race (vs. White); Hispanic ethnicity (vs. non-Hispanic or Latino); Medicaid insurance (vs. Medicare); and treatment by a nonretina specialist were associated with lower odds of receiving ≥7 injections. For both treatment exposure groups, BCVA <20/200 to 20/400 (vs. 20/100-20/200) was associated with greater visual gains, whereas BCVA >20/80, age ≥85 years (vs. 75-84 years), treatment by a nonretina specialist, and Medicaid insurance were associated with lower BCVA gains.
CONCLUSIONS: Over one-third of newly diagnosed eyes with nAMD received <7 anti-VEGF injections and experienced worse visual outcomes at year 1 versus eyes receiving ≥7 injections. Race, insurance type, and physician specialty impacted treatment exposure in nAMD management, whereas age, baseline BCVA, and insurance type impacted visual outcomes regardless of treatment exposure.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Retrospective analysis.
PARTICIPANTS: Treatment-naive eyes with baseline best-corrected visual acuity (BCVA) ≥20/400, from patients aged ≥55 years with nAMD diagnosed from January 1, 2013 to December 31, 2019.
METHODS: This analysis included eyes from the American Academy of Ophthalmology IRIS Registry® (Intelligent Research in Sight). Visual outcomes were evaluated by treatment exposure (≥7 or <7 intravitreal anti-VEGF injections) through year 1. Baseline factors associated with ≥7 anti-VEGF injections and impact of treatment exposure on visual outcomes were evaluated by logistic regression.
MAIN OUTCOME MEASURES: Best-corrected visual acuity change from baseline by treatment exposure, association between baseline factors and treatment exposure, and magnitude of BCVA change by baseline factors and treatment exposure at year 1.
RESULTS: Of 295 561 eligible eyes, 184 258 actively treated were analyzed (≥7 anti-VEGF injections: 109 696 eyes [59.5%]; <7 injections: 74 562 eyes [40.5%]). At year 1, eyes receiving ≥7 injections achieved greater BCVA gains versus those receiving <7 injections (least squares mean change [95% confidence interval]: +3.4 [3.3-3.5] vs. -0.2 [-0.3 to 0.0] letters). Asian or Black race (vs. White); Hispanic ethnicity (vs. non-Hispanic or Latino); Medicaid insurance (vs. Medicare); and treatment by a nonretina specialist were associated with lower odds of receiving ≥7 injections. For both treatment exposure groups, BCVA <20/200 to 20/400 (vs. 20/100-20/200) was associated with greater visual gains, whereas BCVA >20/80, age ≥85 years (vs. 75-84 years), treatment by a nonretina specialist, and Medicaid insurance were associated with lower BCVA gains.
CONCLUSIONS: Over one-third of newly diagnosed eyes with nAMD received <7 anti-VEGF injections and experienced worse visual outcomes at year 1 versus eyes receiving ≥7 injections. Race, insurance type, and physician specialty impacted treatment exposure in nAMD management, whereas age, baseline BCVA, and insurance type impacted visual outcomes regardless of treatment exposure.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Предметные рубрики MeSH
HumansRetrospective StudiesIntravitreal InjectionsAngiogenesis InhibitorsVisual AcuityMaleFemaleUnited StatesVascular Endothelial Growth Factor AAgedWet Macular DegenerationRanibizumabTreatment OutcomeFollow-Up StudiesBevacizumabMiddle AgedAged, 80 and overDose-Response Relationship, DrugTomography, Optical Coherence