Larger choroidal neovascular area predicts vision loss despite anti-VEGF therapy

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The likelihood of vision loss at 3 months or 1 year despite anti-VEGF therapy increased significantly in patients who had larger choroidal neovascular area (CNV) at baseline, French researchers reported.

Increased CNV area had significant associations with early (within 3 months) and late ≥5 letters vision loss. The presence of subretinal fluid (SRF) at 3 months was associated with vision loss ≥ 5 letters, and the association was strengthened with the presence of both SRF and intraretinal fluid (IRF).

The findings are consistent with a post hoc analysis of the VIEW randomized trial, which also identified CNV area as a factor in vision loss during anti-VEGF treatment for neovascular age-related macular degeneration, Laurent reported. Kodjikian, MD, PhD, from Croix-CHU Rousse in Lyon, France, and co-authors, in Ophthalmology Retina.

“In search of predictors of vision loss that may determine whether the patient belongs to one or another of these risk groups [for vision loss] could allow early identification of a visual prognosis and justify more intensive treatment regimens for some patients, if appropriate,” the team wrote. “We found that only the CNV base area was correlated with the visual trajectory.

“The similarity of our results with the post hoc analysis of the VIEW study suggests that the CNV base zone is a predictor of vision loss independent of the treatment regimen and the anti-VEGF molecule used”, have added the authors.

The vision loss observed in the study is consistent with other studies and shows that most patients with neovascular or wet AMD do well when treated appropriately, said Sunir Garg, MD, of Wills Eye Hospital and Thomas Jefferson University of Philadelphia, which was unaffiliated with the study.

“However, some eyes, especially those with larger wet macular degeneration lesions at baseline, are at higher risk of vision loss over time,” said Garg, clinical spokesperson for the American Academy. of Ophthalmology. MedPage today by email.

Recent advances have improved the early recognition of AMD, he continued. A simple at-home test involves covering one eye and then the other to see if straight lines become wavy or distorted, a possible sign of wet macular degeneration. Automated home screening tests are also available.

“In the near future, we hope to have a home-based optical coherence tomography (OCT) screening system,” Garg said. “OCT is the primary image we use to diagnose and monitor response to treatment in eyes with wet macular degeneration. A few companies are working on a version that patients can take from the comfort of their home, and it can detect development of wet macular degeneration hopefully at a very early stage.”

Although the development of anti-VEGF therapy has dramatically improved outcomes in neovascular AMD, some patients (15-23% in recent studies) have significant vision loss despite treatment, Kodjikian and co-authors noted. . In the GEFAL randomized trial comparing bevacizumab (Avastin) and ranibizumab (Lucentis), French researchers found that 9-10% of patients lost at least 15 letters during the first year of treatment.

“Early identification of these patients with poorer outcomes at 1 year would allow their treatment regimens to be adjusted to prevent vision loss,” the authors said.

The GEFAL investigators retrospectively reviewed the 1-year data of the 393 randomized patients. They separated the patients into three categories according to the evolution of the best corrected visual acuity (BCVA) at 3 months and 1 year: no loss of vision ≥ 5 letters at either evaluation; no vision loss ≥ 5 letters at 3 months but loss ≥ 5 letters at 1 year (secondary loss); patients with ≥ 5 letters at 3 months and 1 year (initial loss).

The study population had an average age of 79 years and women represented 67% of the total. The mean initial BCVA was 55 letters and the mean central macular thickness (CMT) was 357 μm. The CNV was purely occult in 44% of cases, and the mean total CNV area was 2.0 discal areas.

The data showed that 225 (57.3%) patients had no vision loss ≥ 5 letters, 109 (27.7%) had secondary vision loss ≥ 5 letters, and 59 (15%) patients had initial vision loss ≥ 5 letters. The final BCVA differed significantly (P

Baseline total CNV area was significantly greater in patients with secondary or initial loss (disc area of ​​2.2) compared to those without vision loss ≥ 5 letters (1.8, P=0.0412). Neither baseline BCVA nor CMT was associated with vision trajectory.

The presence of SRF at 3 months had a significant association with vision loss (P=0.0286), but not the presence of IRF. The association with baseline vision loss increased with the presence of both SRF and IRF (P=0.0066). The presence of IRF alone was associated with secondary vision loss.

  • Charles Bankhead is editor for oncology and also covers urology, dermatology and ophthalmology. He joined MedPage Today in 2007. To follow

Disclosures

The study was supported by the French Ministry of Health and the French health insurance system.

Kodjikian disclosed relationships with AbbVie-Allergan, Bayer, Alimera-Horus, Roche, Thea and Novartis.

Garg disclosed relationships with Merck Sharp & Dohme, Bausch & Lomb, Allergan, EyePoint Pharmaceuticals and Carl Zeiss Meditec AG.

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