Management of Neovascular Age-Related Macular Degeneration in Routine US Clinical Practice: Impact of Delayed Treatment Initiation.

Abstract

Objective: To understand management of patients with neovascular age-related macular degeneration (nAMD) in routine US clinical practice to identify gaps in patient care.

Design: Retrospective analysis of electronic medical records from the Vestrum database.

Participants: Treatment-naive eyes newly diagnosed with nAMD from January 1, 2014, with ≥1-years' follow-up.

Methods: Cumulative incidence of eyes receiving treatment was evaluated using Kaplan-Meier, and factors predicting anti-VEGF receipt through 1 year were evaluated by logistic regression.

Main outcome measures: Proportion of eyes treated over 3 years, baseline factors associated with receiving treatment within 1 year of diagnosis and with delayed (3-12 months after diagnosis) versus prompt (within 29 days of diagnosis) treatment initiation.

Results: Of 90 681 eyes included in the analysis, 23% did not receive anti-VEGF treatment at diagnosis, declining to 16%, 15%, and 13% at years 1, 2, and 3, respectively. Mean baseline VA of eyes not treated and treated was 39 and 52 letters, respectively. Eyes were more likely to receive treatment (odds ratio [OR] ≥ 1.50, [95% CI]) if they had baseline VA 20/40-20/100 versus ≥ 20/40 (1.52 [1.44, 1.61]), macular edema (3.26 [3.11, 3.42]), subretinal fluid (4.97 [4.75, 5.20]), or subretinal pigment epithelium fluid (1.64 [1.56, 1.72]). Eyes were less likely to receive treatment (OR ≤ 0.50) if they had simultaneous bilateral diagnosis of nAMD vs. unilateral diagnosis (0.32 [0.31, 0.34]), or baseline VA < 20/400 versus ≥ 20/40 (0.29 [0.27, 0.30]). Mean change in VA from baseline at 1 year was +5 and -3 letters in the prompt and delayed treatment groups, respectively. Mean VA change from baseline at year 1 was -1.2, 0.6, 4.3, and 5.6 letters in eyes treated with 1-3, 4-6, 7-9, and >9 injections, respectively. In eyes that received >9 injections, those with baseline VA < 20/400 gained 27.2 letters.

Conclusions: Overall, approximately one-quarter of eyes with nAMD were not treated within 29 days of diagnosis. Simultaneous bilateral nAMD diagnosis and poor baseline VA (< 20/400) were primary factors associated with not receiving anti-VEGF treatment. Greater VA gains were observed with prompt treatment and increasing number of injections.