Prevalence and characteristics of macular atrophy in eyes with neovascular age-related macular degeneration. A study from a long-term observational dataset: the Fight Retinal Blindness! project

To assess the prevalence and characteristics associated with macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors. This was a retrospective, cross-sectional study of nAMD eyes that commenced anti-VEGF...

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Bibliographic Details
Published in:	British journal of ophthalmology Vol. 104; no. 8; p. 1064
Main Authors:	Daien, Vincent, Nguyen, Vuong, Essex, Rohan W, Guymer, Robin, Arnold, Jennifer J, Munk, Marion, Ceklic, Lala, Gillies, Mark C, Barthelmes, Daniel
Format:	Journal Article
Language:	English
Published:	England 01-08-2020
Subjects:	Aged Aged, 80 and over Angiogenesis Inhibitors - therapeutic use Atrophy - diagnosis Atrophy - epidemiology Choroidal Neovascularization - complications Choroidal Neovascularization - drug therapy Choroidal Neovascularization - physiopathology Cross-Sectional Studies Datasets as Topic Female Fluorescein Angiography Follow-Up Studies Geographic Atrophy - diagnosis Geographic Atrophy - epidemiology Geographic Atrophy - physiopathology Humans Intravitreal Injections Macula Lutea - pathology Macular Degeneration - complications Macular Degeneration - drug therapy Macular Degeneration - physiopathology Male Prevalence Ranibizumab - therapeutic use Receptors, Vascular Endothelial Growth Factor - therapeutic use Recombinant Fusion Proteins - therapeutic use Retrospective Studies Risk Factors Tomography, Optical Coherence Vascular Endothelial Growth Factor A - antagonists & inhibitors Visual Acuity neovascularisation vision retina
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Summary:	To assess the prevalence and characteristics associated with macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors. This was a retrospective, cross-sectional study of nAMD eyes that commenced anti-VEGF between January 2006 and August 2016. MA (absent/extrafoveal/subfoveal) was graded by treating practitioners based on multimodal imaging from April 2016. The prevalence of MA over time and risk factors of MA were assessed. The prevalence of MA in a cohort of 1689 eyes was 9.9% (22/222) in eyes within 1 year of starting treatment, 41.5% (71/171) after 5 years and 48.4% (30/62) after 9 years of treatment. Risk factors for subfoveal MA included the proportion of visits at which the lesion was graded as inactive ((adjusted OR (AOR) 3.72 for the highest vs lowest the quartile of frequency of inactive gradings (95% CI 2.33 to 6.07)), age (AOR 1.05 per year (95% CI 1.02 to 1.07)), baseline visual acuity (AOR 3.9 for ≤35 letters vs ≥70 letters (95% CI 2.4 to 6.4)) and the number of injections received (AOR 1.20 every 10 injections (95% CI 1.08 to 1.33)). Similar associations were observed with extrafoveal MA. The risk of MA appeared to drop in eyes that had not developed it within 5 years. Low choroidal neovascularisation activity was by far the strongest predictor. We could not determine whether the increased prevalence of MA with time was due to anti-VEGF treatment or the natural history of the condition.
ISSN:	1468-2079
DOI:	10.1136/bjophthalmol-2019-315055