Progression and Incidence of Geographic Atrophy in Patients with Wet Age-Related Macular Degeneration undergoing Anti- VEGF Therapy

Importance: Age Related Macular Degeneration (AMD) is one of the leading causes of blindness in the developed world. There are two phenotypes of AMD as defined by the United Kingdom Department of Health: neovascular AMD (nAMD) and geographic atrophy (GA). GA can develop after nAMD as well. There is recent evidence of the development of GA after anti-vascular endothelial growth factor (anti-VEGF) treatment. Our study aims to assess the percentage, risk factors and characteristics of patients developing GA after the different anti-VEGF medications for nAMD.

Observations: We retrospectively reviewed case records of 1415 eyes diagnosed with nAMD treated with anti-VEGF for a period of 60 months. Pre and post anti-VEGF treatment characteristics were recorded. Main outcome measures were the number of patients that developed GA after treated for nAMD with aflibercept, ranibizumab and bevaciumab. Secondary outcome measures included the following: number of injections per type, mean change in the best corrected visual acuity (BCVA), area of GA, central macular thickness (CMT), and the proportion of patients showing change in intra- retinal fluid (IRF), sub-retinal fluid (SRF) and pigment epithelial detachment (PED). 109 eyes (7.7%) developed GA after the last assessment. The number of injections was significantly related to the development of GA, R2=0.000246358, P<0.01. Other studied variables could not significantly predict development or progression of GA.

Conclusion and relevance: In the era of antiVEGF for nAMD treatment, we need to take into account the risk of excessive treatment. Considering GA treatment is still under research the perfect balance between treatment and withholding still needs to be found. In addition other associations or risk factors for GA development after anti-VEGF need to be researched.