Ten-year survival trends of neovascular age-related macular degeneration at first presentation

Background To describe 10-year trends in visual outcomes, anatomical outcomes and treatment burden of patients receiving antivascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD). Methods Retrospective cohort study of treatment-naive, first-affected eyes with nAMD started on ranibizumab before January 1, 2009. The primary outcome was time to best-corrected visual acuity (BCVA) falling <= 35 ETDRS letters after initiating anti-VEGF therapy. Secondary outcomes included time to BCVA reaching >= 70 letters, proportion of eyes with BCVA >= 70 and <= 35 letters in 10 years, mean trend of BCVA and central retinal thickness over 10 years, and mean number of injections. Results For our cohort of 103 patients, Kaplan-Meier analyses demonstrated median time to BCVA reaching <= 35 and >= 70 letters were 37.8 (95% CI 22.2 to 65.1) and 8.3 (95% CI 4.8 to 20.9) months after commencing anti-VEGF therapy, respectively. At the final follow-up, BCVA was <= 35 letters and >= 70 letters in 41.1% and 21%, respectively, in first-affected eyes, while this was the case for 5.4% and 48.2%, respectively, in a patient's better-seeing eye. Mean injection number was 37.0 +/- 24.2 per eye and 53.6 +/- 30.1 at patient level (63.1% of patients required injections in both eyes). Conclusions The chronicity of nAMD disease and its management highlights the importance of long-term visual prognosis. Our analyses suggest that one in five patients will retain good vision (BCVA >= 70 ETDRS letters) in the first-affected eye at 10 years after starting anti-VEGF treatment; yet, one in two patients will have good vision in their better-seeing eye. Moreover, our data suggest that early treatment of nAMD is associated with better visual outcomes.