Characteristics and Outcomes of Patients with Neovascular AMD by Anti-VEGF Exposure in US Clinical Practice.

Objective: To assess 1-year visual outcomes of patients in routine clinical practice treated with ≥ 7 anti-VEGF injections for neovascular age-related macular degeneration (nAMD), baseline characteristics associated with receiving ≥ 7 anti-VEGF injections, and impact of treatment exposure on visual outcomes.

Design: Retrospective analysis.

Participants: Treatment-naive eyes with baseline best-corrected visual acuity (BCVA) ≥ 20/400, from patients aged ≥ 55 years with nAMD diagnosed from January 1, 2013 - December 31, 2019.

Methods: This analysis included eyes from the American Academy of Ophthalmology Intelligent Research in Sight (AAO) IRIS® Registry. Visual outcomes were evaluated by treatment exposure (≥ 7 or < 7 intravitreal anti-VEGF injections) through Year 1. Baseline factors associated with ≥ 7 anti-VEGF injections and impact of treatment exposure on visual outcomes were evaluated by logistic regression.

Main outcome measures: BCVA change from baseline by treatment exposure, association between baseline factors and treatment exposure, and magnitude of BCVA change by baseline factors and treatment exposure at Year 1.

Results: Of 295,561 eligible eyes, 184,258 actively treated were analyzed (≥ 7 anti-VEGF injections: 109,696 eyes [59.5%]; < 7 injections: 74,562 eyes [40.5%]). At Year 1, eyes receiving ≥ 7 injections achieved greater BCVA gains versus those receiving < 7 injections (least squares mean change [95% confidence interval; CI]: +3.4 [3.3 to 3.5] vs. -0.2 [-0.3 to 0.0] letters). Asian or Black race (vs. White); Hispanic ethnicity (vs. non-Hispanic or Latino); Medicaid insurance (vs. Medicare); and treatment by a non-retina specialist were associated with lower odds of receiving ≥ 7 injections. For both treatment exposure groups, BCVA < 20/200 -20/400 (vs. 20/100-20/200) was associated with greater visual gains, while BCVA > 20/80, age ≥ 85 years (vs. 75-84 years), treatment by a non-retina specialist, and Medicaid insurance were associated with lower BCVA gains.

Conclusions: Over one-third of newly diagnosed eyes with nAMD received < 7 anti-VEGF injections and experienced worse visual outcomes at Year 1 versus eyes receiving ≥ 7 injections. Race, insurance type, and physician specialty impacted treatment exposure in nAMD management, while age, baseline BCVA, and insurance type impacted visual outcomes regardless of treatment exposure.