Long-term outcomes of the observe-and-plan regimen in treating neovascular age-related macular degeneration: a retrospective real-life analysis

TL;DR

This study shows that a treatment plan for a type of eye disease called neovascular age-related macular degeneration can maintain good vision and reduce the need for frequent treatments over seven years.

Contribution

The study demonstrates the long-term effectiveness and efficiency of the observe-and-plan regimen in real-life treatment of nAMD.

Findings

Patients maintained improved vision (70 letters) and reduced retinal thickness over seven years.

The number of injections decreased over time, reducing the treatment burden.

The regimen proved efficient in real-life settings with consistent visit frequency.

Abstract

This study aimed to evaluate the long-term (7 years) outcome of visual acuity in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents following the observe-and-plan regimen.

A total of 195 eyes from 181 patients with nAMD (mean age 79.5 ± 6.9 years), with a mean follow-up duration of 66 ± 37 months, treated with intravitreal anti-VEGF (ranibizumab or aflibercept) were included in this retrospective study. The principles of the observe-and-plan regimen were followed, with follow-up exceeding 3 years in real-life settings. Data collected included visual acuity (VA), number of injections and visits, central retinal thickness, and any complications over 7 years from baseline.

The mean baseline VA was 63 ± 17 Early Treatment of Diabetic Retinopathy Study letters (Snellen equivalent 20/63), improving to 73 ± 14 at year 1. The initial visual gain was slightly reduced with a final mean VA of 70 ± 18 letters (Snellen equivalent 20/40) at year 7. The mean central macular thickness decreased significantly from 375 ± 129 at baseline to 276 ± 75 at year 1 and to 279 ± 87 at year 7. The mean annual number of injections decreased from 8.7 ± 3.2 in year 1 to 6.7 ± 3.7 in year 2 and to 5.5 ± 2.8 in year 7. The mean annual number of visits remained constant throughout, with 4.1 ± 1.3 visits in year 1 and 4.7 ± 1.7 in year 7.

The observe-and-plan regimen was very efficient for treating nAMD in real-life settings, reducing the clinical burden on the medical system and patients, with excellent functional and structural long-term results.

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