May 31, 2019 Conference


Projection of Visual Outcome after Converting to Aflibercept for Refractory Neovascular Age-Related Macular Degeneration

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Mr. Jim McCullum, Lahey Hospital & Medical Center (Presenter)
Dr. David Ramsey, Lahey Hospital and Medical Center
Yubo Zhang, Brandeis University
Elise Steinberger, Tufts University School of Medicine

Purpose: To determine factors that predict 3-year visual acuity (VA) outcomes in patients converted to intravitreal aflibercept (IVA) from intravitreal bevacizumab (IVB) or intravitreal ranibizumab (IVR) for treatment refractory neovascular age related macular degeneration (nAMD).

Methods: 43 eyes from 40 patients treated with IVB/IVR and converted to IVA during a 3-year course. Visual acuity data was collected at baseline, the first 3 loading doses, and at 3-year follow-up. 

Results: Good visual acuity (VA), defined as >=70 letters (20/40 Snellen equivalent), at the 4th loading dose of anti-VEGF was the best predictor of 3-year VA outcome (OR 7.44; 95% CI, 1.85-29.96; P=0.005). Good baseline VA, absolute change in VA from baseline, time to first grading of the choroidal neovascular lesion as inactive, and rate of VA change did not predict 3-year VA outcome.

Conclusion: Achieving good VA (>=70 letters; Snellen equivalent, 20/40) by the 4th injection is a useful marker to predict 3-year visual acuity outcome in treatment refractory nAMD.