Real-world 10-year experiences with intravitreal treatment with ranibizumab and aflibercept for neovascular age-related macular degeneration

Purpose To report 10-year, real-world experiences with intravitreal therapy (IVT) using vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration (nAMD). Methods Retrospective single-centre review of IVT-log 2007-2019 with a treatment-as-needed regimen and ETDRS visual acuity charts. Results The 4,678 treatment-naive eyes of 3,668 patients received a mean of 5.4 IVT in the first year and 4.0-4.3 IVT yearly thereafter. Baseline mean best corrected visual acuity (BCVA) was 57.9 (+/- 16.4) letters (6/18) that improved a mean +2.1 (+/- 0.2) letters at the first follow-up visit and gradually declined to -5.0 (+/- 2.2) letters after 10 years. At baseline, there were 29% with BCVA >= 6/12. This proportion increased to 31-37% until year 9. There were 8% with BCVA loss of >= 3 lines at the first follow-up visit increasing to 34% after 10 years. Poorer baseline BCVA was associated with larger increase in BCVA (p < 0.0001, multiple linear regression). The 2,566 (55%) discontinued eyes had a mean baseline BCVA of 56.9 (+/- 16.4) letters compared with 61.5 (+/- 15.9) letters for eyes remaining in treatment. In year 0-7, the discontinued eyes lost an additional mean 2-4 letters (last observation carried forward) but were similar thereafter. There were 12.6% (74 of 585 eligible eyes) that were still in treatment after 10 years. At baseline, 10% had bilateral nAMD. Of patients with unilateral presentation, 17% had received fellow-eye IVT after 5 years. Conclusion A treatment-as-needed regimen stabilized BCVA in active nAMD up to 10 years in most eyes. Baseline BCVA was the most important prognostic factor.