Visual acuity losses during ongoing anti VEGF injections

Patients with wet age-related macular degeneration (AMD) experienced ongoing ocular damage and visual acuity loss while being treated with anti-vascular endothelial growth factor (anti-VEGF) drugs in the later years of a five-year study.

The research, presented at the Association for Research in Vision and Ophthalmology conference this month (1–5 May, Seattle), tracked 647 patients with AMD for an average of 5.5 years.

Visual gains were seen in the first two years of the drug treatment, but were not maintained at the five-year mark, study co-author, Dr Daniel Martin, highlighted.

At the latest follow up, the patients’ visual acuity had worsened, with a loss of three letters from baseline and a loss of 11 letters from the second-year measurements, the paper explained.

Dr Martin and his research team concluded that, despite such losses, anti-VEGF drugs offered a “major long-term therapeutic advantage” as more than half of patients had a visual acuity of 6/12 or better.

On the visual degradation, he added: “Additionally, this decrease in vision was accompanied by expansion of the size of the total neovascular complex and increased rates of geographic atrophy.”

The patients in the trial had been randomly assigned to receive either Lucentis or Avastin in either a monthly injection, or on an as-needed basis, to allow comparison of the anti-VEGF drugs. However, over the study period, most patients were treated at least once with an AMD drug other than the one they were assigned, which complicated the analysis.

However, the study did conclude that in the later three years of the study, the patients in the Avastin group had a significantly smaller visual acuity loss than those originally assigned to receive Lucentis.

At the five-year mark, two in five patients with gradable eyes had geographic atrophy and four out of five had fluid seen in an optical coherence tomography scan, the paper noted.

The study participants had an average of 25 AMD care visits.