Author(s): Okeagu CU, Agrón E, Vitale S, Domalpally A, Chew EY, Keenan TDL; AREDS2 Research Group. Principal cause of poor visual acuity following neovascular age-related macular degeneration: AREDS2 Report Number 23. Ophthalmol Retina. 2020 Oct 9. pii: S2468-6530(20)30408-5. doi: 10.1016/j.oret.2020.09.025. [Epub ahead of print] PMID 33045457
Journal: Ophthalmology. Retina, Oct 2020
PURPOSE To analyze the principal cause for poor vision in eyes with best-corrected visual acuity (BCVA) ≤20/200 two years after a record of neovascular age-related macular degeneration (NV-AMD).
DESIGN Prospective cohort study of participants enrolled in a clinical trial of oral supplements and receiving anti-VEGF therapy in routine clinical practice.
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PARTICIPANTS Age-Related Eye Disease Study 2 (AREDS2) participants (50-85 years) whose eyes met AREDS2 inclusion criteria at baseline (no late AMD; BCVA ≥20/100; no previous anti-VEGF injections) but began anti-VEGF therapy for incident NV-AMD during follow-up and had data available at two years.
METHODS Participants underwent refracted BCVA testing, ophthalmoscopic examination, and color fundus photography (CFP) at baseline and annual study visits. Self-reports of anti-VEGF injections were collected.
MAIN OUTCOME MEASURES Principal cause of BCVA ≤20/200 at two years, detected on CFP grading.
RESULTS Of the 594 eligible eyes, the number with BCVA ≤20/200 at two years was 56 eyes (9.4%). Mean BCVA was 14.9 letters (SD 12.3; 20/500), versus 70.1 letters (SD 12.8; 20/40) in the other group. Of the 55 eyes with CFP available at two years, 33 (60.0%) were assessed from CFP grading to have central macular atrophy as the principal cause for poor vision. The remaining 22 eyes (40.0%) were assessed to have central subretinal fibrosis. The group with poor BCVA had a higher proportion of non-white participants (8.9% vs 1.7%, p=0.006), lower BCVA two years earlier (mean 38.0, SD 26.7, 20/160 vs 71.8, SD 11.9, 20/40, p<0.0001), higher proportion with macular atrophy two years earlier (26.8% vs 12.3%, p=0.003), higher proportion with macular hemorrhage (25.5% vs 13.2%, p=0.014), and fewer anti-VEGF injections (7.6 vs 10.2, p=0.001).
CONCLUSIONS BCVA data and CFP were obtained in a clinical trial environment but related to anti-VEGF therapy given in routine clinical practice. At two years after starting anti-VEGF therapy, almost one in ten eyes had BCVA at the level of legal blindness. From CFP grading, the cause of poor vision appeared to be macular atrophy in 60% and subretinal fibrosis in 40%. These data may be useful in understanding the long-term limits to good vision in NV-AMD.