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

• 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
• ISSN: 1468-2079
• DOI: 10.1136/bjophthalmol-2019-315055

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.