Comparison of Neovascular Age-Related Macular Degeneration Outcomes in Established vs New Patients of a Retina Practice.

Abstract

Purpose: To compare the treatment outcomes of newly diagnosed unilateral neovascular age-related macular degeneration (nAMD) in established patients of a retina practice with those of patients referred by non-retina specialist providers. Methods: This is a retrospective cohort study of patients with unilateral nAMD treated with intravitreal antivascular endothelial growth factor (anti-VEGF) therapy and at least 12 months of follow-up. Group 1 included established patients with initially bilateral dry age-related macular degeneration (AMD) that subsequently converted to unilateral nAMD requiring anti-VEGF treatment. Group 2 patients were referred to the practice with newly diagnosed unilateral nAMD requiring anti-VEGF treatment. All included patients presented with cases of new neovascular disease of the first eye. Results: There were 253 patients in Group 1 and 392 in Group 2. Average logMAR (Snellen equivalent) best-corrected visual acuity (BCVA) at time of neovascular conversion was 0.40 (20/50) for Group 1 and 0.62 (20/80) for Group 2 (P < .001). The percentage of patients with submacular hemorrhage was 7.9% for Group 1 and 18.6% for Group 2 (P < .001). By 12 months, BCVA improved to 0.36 (20/40) for Group 1 and 0.52 (20/60) for Group 2 (P < .001). The mean ± SD number of injections in the first 12 months of therapy was 8.64 ± 2.17 for Group 1 and 9.19 ± 2.33 for Group 2 (P = .003). Conclusions: Visual outcomes were superior in established patients of retina specialists at the time of nAMD conversion in the first eye. It may be advantageous for patients with dry AMD to already be under the care of a retina specialist at the time of neovascular conversion.