Second treated eyes with nAMD functionally more important than first eyes

By Afsaneh Gray, medwireNews Reporter

A real-world study of the characteristics of second treated eyes in patients with neovascular age-related macular degeneration (nAMD) given ranibizumab in the UK National Health Service has shown that these eyes start off with better baseline visual acuity (VA) than first treated eyes and, despite a poor response to therapy, maintain this advantage.

The researchers also found that there was a high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years.

“Data from this study… highlight the need for regular OCT [optical coherence tomography] monitoring of fellow eyes to detect disease early and to achieve optimal VA outcomes for patients”, they write in Ophthalmology.

They add that because second treated eyes are specifically excluded from clinical trials to avoid bias, there is a lack of high-quality data about the incidence, baseline characteristics and visual outcomes of nAMD development and treatment in second eyes of patients with nAMD in one eye.

Up to 5 years of routinely collected, anonymised data within electronic medical record systems were extracted remotely from 14 UK centres that exclusively used ranibizumab to treat nAMD. This yielded a total of 11,135 patients receiving ranibizumab for nAMD, of which 1816 had received treatment in their second eye by the end of the study.

Patients were treated with a loading phase of 3 monthly injections followed by monthly follow-up visits and further treatment as deemed necessary.

Mean baseline VA for first treated eyes was 0.66 logMAR, with final VA almost the same at 0.65 logMAR. For second treated eyes, baseline VA was 0.41 logMAR and final VA was 0.56 logMAR. For both first and second treated eyes, the rate of VA loss after the loading phase of treatment was similar (0.03 vs 0.05 logMAR units/year).

If the researchers excluded second eyes with baseline VA worse than 20/200 to limit their analyses to eyes at risk of nAMD, the rate of second eye involvement was 14% per year and 42% over 3 years.

The amount of vision gained in both eyes was less than that reported in major trials, which lead author Adnan Tufail (Moorfields Eye Hospital, London, UK) and colleagues attribute to the real-world setting of their study.

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