Macular Atrophy Incidence, Progression, and Visual Acuity Effects in 5-Year Treatment of Neovascular Age-Related Macular Degeneration

BACKGROUND AND OBJECTIVE: Macular atrophy (MA) contributes to declining vision during pro-longed anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macu-lar degeneration (nAMD) so greater understanding of its incidence, evolution, and impact on visual acuity is merited.MATERIALS AND METHODS: This is a retrospective review of nAMD patients receiving anti-VEGF ther-apy for >= 5 years. Near-infrared reflectance images and vision data were extracted every 6 months. MA lesion areas were measured using ImageJ.RESULTS: Vision showed a mean decline of-1.2 let-ters/year. Eyes with MA showed a greater decrease of-1.6 letters/year compared to eyes without MA (-0.7 letters/year). Cumulative incidence of MA was 38% at 5 years. MA was significantly associ-ated with declining vision, showing a-0.7 letter de-crease for every 1 mm2 increase in lesion size.CONCLUSION: Over a 5-year course of nAMD treat-ment, MA affected most eyes, and MA progression was significantly associated with vision decline.