Predictors of Visual Response After Lapse in Treatment Among Patients With Neovascular Age-related Macular Degeneration.

Abstract

Background and objective: This study aimed to analyze baseline predictors of visual response in patients with neovascular age-related macular degeneration (nAMD) who have undergone lapses in treatment with anti-VEGF therapy. The mainstay treatment option for nAMD is intravitreal vascular endothelial growth factor inhibitor (anti-VEGF) therapy. Given the chronic nature of nAMD, patients who undergo lapses in treatment with these agents can have progression of their disease.

Patients and methods: This retrospective, comprehensive chart review included 261 adults aged 18 years or older who were diagnosed with nAMD between January 2012 and June 2020 and had undergone at least one anti-VEGF injection prior to an unintended lapse in follow-up of 3 months or greater. Following exclusion criteria, in which individuals were not administered an anti-VEGF injection at the pre-lapse visit, a total of 163 patients were analyzed. Patients were separated into "vision loss" and "stable vision" categories and classified based on degree of vision loss. A stepwise backward logistic regression was used to analyze baseline medical and ophthalmic factors between each group to determine which factors were more likely to be associated with more significant vision loss.

Results: Out of 261 nAMD patients reviewed, 163 patients were investigated in the main analysis. Higher cube volume (1.24 ± 0.24, P = 0.22), and lapse length (2.89 ± 0.056, P = 0.004) increased the likelihood of vision loss, while lack of smoking history (-2.07 ± 0.46, P = 0.038) decreased the likelihood. The two groups were significantly different in post-lapse ophthalmologic continuous variables, including cube volume (9.69 ± 0.98 and 10.2 ± 1.39 in the stable vision and unstable vision groups, respectively, P = 0.01) and cube average thickness (269 ± 27.3 and 282 ± 38.4 in the stable vision and unstable vision groups, respectively, P = 0.02). The main model had an area under the curve (AUC) of 58% and predictive accuracy of 78.1%.

Conclusion: The calculated AUC was not high enough to establish reliable predictability in this study. However, additional factors may need to be considered for greater predictability. [Ophthalmic Surg Lasers Imaging Retina 2025;56:280-285.].