Three-year follow-up of ranibizumab treatment of wet age-related macular degeneration: influence of baseline visual acuity and injection frequency on visual outcomes

AbstractA remarkable proportion of neovascular age-related macular degeneration (nAMD) patients respond rather poorly to ranibizumab treatment, in spite of the minimum 4-week follow-up and treatment interval. Usually, retreatments are based on nAMD activity as evaluated by Spectral-domain Optical coherence Tomography (SD-OCT), biomicroscopic fundus examination and visual acuity changes. In this prospective pilot study, we aimed to study SD-OCT changes in a high-frequent follow-up manner (weekly (month 0–6), biweekly (month 7–12)) throughout the first year, which consequently led to intravitreal ranibizumab being administered up to biweekly. Best corrected visual acuity (BCVA) was already significantly improved at week 2. Central retinal thickness (CRT), intraretinal and subretinal fluid (SRF) were significantly improved from week 1 onwards. Half of the patients showed nAMD activity at week 2 or 3 and received the first retreatment earlier than 4 weeks after baseline injection. In total, 46% of retreatments were already applied 2 or 3 weeks after the previous treatment. Greater range of CRT and SRF fluctuation during follow-up was associated with lower final BCVA. Lower baseline BCVA and better SRF improvement at week 2 was associated with greater BCVA improvement. In conclusion, high-frequency SD-OCT follow-up provided a good option for adapting treatment in nAMD individually.

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Baseline visual acuity as a prognostic factor for visual outcomes in patients treated with aflibercept for wet age-related macular degeneration: data from the INSIGHT study using the Swedish Macula Register

Acta Ophthalmologica ◽

10.1111/aos.13864 ◽

2018 ◽

Vol 97 (1) ◽

pp. 91-98 ◽

Cited By ~ 5

Author(s):

Monica Lövestam Adrian ◽

Zdravko P. Vassilev ◽

Inger Westborg

Keyword(s):

Visual Acuity ◽

Prognostic Factor ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Visual Outcomes ◽

Age Related ◽

Baseline Visual Acuity

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An overview of age-related macular degeneration and its management using external beam radiotherapy

Journal of Radiotherapy in Practice ◽

10.1017/s1460396999000023 ◽

1999 ◽

Vol 1 (1) ◽

pp. 3-9

Author(s):

John Newnham

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

External Beam Radiotherapy ◽

Age Related Macular Degeneration ◽

Western World ◽

Rapid Progression ◽

External Beam ◽

Age Related ◽

Radiation Induced

This paper aims to provide an overview of age related macular degeneration (ARMD) and its radiotherapy management.ARMD is already the leading cause of adult blindness in the western world. The neovascular form of ARMD is responsible for some 85% of blindness caused by ARMD as a whole. Its aetiology is unknown. The natural course of the disease is rapid progression from onset to disciform scarring and accompanying loss of visual acuity. Laser photocoagulation is only suitable for 10% of patients with neovascular ARMD. Initial studies using low dose fractionated external beam radiotherapy have demonstrated stable visual acuity over the range of 40–93% at short term follow-up. Only transient acute side effects have been observed. No radiation-induced retinopathy or vasculopathy have been observed. Common radiotherapy macula techniques are reviewed, field sizes examined and criteria for a simple macula technique proposed. A subset of patients with rapidly progressing neovascular ARMD may be candidates for rapid treatment starts. Although follow up times have been short, radiotherapy is a promising option for those patients facing imminent blindness due to rapidly progressive neovascular ARMD.

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Impact of injection frequency on 5-year real-world visual acuity outcomes of aflibercept therapy for neovascular age-related macular degeneration

Eye ◽

10.1038/s41433-020-0851-y ◽

2020 ◽

Author(s):

Shruti Chandra ◽

Rajna Rasheed ◽

Deepthy Menon ◽

Namritha Patrao ◽

Ali Lamin ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Real World ◽

Age Related Macular Degeneration ◽

Age Related ◽

Injection Frequency

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Evaluation of Injection Frequency and Visual Acuity Outcomes for Ranibizumab Monotherapy in Exudative Age-related Macular Degeneration

Ophthalmology ◽

10.1016/j.ophtha.2009.05.033 ◽

2009 ◽

Vol 116 (9) ◽

pp. 1740-1747 ◽

Cited By ~ 88

Author(s):

Hajir Dadgostar ◽

Alexandre A.C.M. Ventura ◽

Jeffrey Y. Chung ◽

Sumit Sharma ◽

Peter K. Kaiser

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Age Related ◽

Injection Frequency

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Correlation Between Improvement in Visual Acuity and QOL After Ranibizumab Treatment for Age-related Macular Degeneration Patients: QUATRO Study

10.21203/rs.3.rs-116089/v1 ◽

2020 ◽

Author(s):

Yuji Oshima ◽

Yumi Ishibashi ◽

Naoyasu Umeda ◽

Tatsuo Nagata ◽

Shigeo Yoshida ◽

...

Keyword(s):

Visual Acuity ◽

Patient Satisfaction ◽

Visual Function ◽

Age Related Macular Degeneration ◽

Open Label ◽

Satisfaction Questionnaire ◽

Age Related ◽

The Mean ◽

Baseline Visual Acuity ◽

Ranibizumab Treatment

Abstract Background: To evaluate the correlation between visual acuity improvement and vision-related QOL after ranibizumab treatment in Japanese patients with AMD.Methods: In this one-year prospective, interventional, open-label, multicenter study involving four sites, patients with neovascular AMD were enrolled and observed for 12 months. Treatment-naïve patients received 0.5 mg ranibizumab as needed (PRN) after three initial monthly doses. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at every visit. Fluorescein and indocyanine green angiography, and evaluations with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and patient satisfaction questionnaire were performed at baseline and 3 and 12 months after initial treatment. The primary endpoint was the change in BCVA and QOL 3 months after ranibizumab treatment. Secondary endpoints included change in BCVA, QOL, CMT, and patient satisfaction over 12 months.Results: The study enrolled 100 patients. The mean logMAR BCVA after the 3-month treatment improved significantly from 0.43 to 0.30 (p<0.0001). The mean NEI-VFQ-25 composite scores were higher after 3 months of ranibizumab treatment, improving from 79.48 to 84.13 (p<0.0001). The changes in the NEI-VFQ-25 score and BCVA showed significant correlation in the poor baseline visual acuity group (decimal BCVA below 0.5, p=0.02) but not in the better baseline visual acuity group (decimal BCVA above 0.6, p=0.1) after the three loading doses. There were no significant differences in the satisfaction questionnaire score from baseline to after the three loading doses (p=0.5466). The average CMT improved significantly from 340 to 264 mm after the loading doses (p<0.0001).Conclusions: Intravitreal ranibizumab treatment resulted in improvement in visual acuity, anatomical change, and visual function change in Japanese AMD patients. Significant improvement was seen in patient visual function, but this was not correlated with changes in VA in patients with higher or lower baseline VA. The patients' satisfaction with the treatment remained unchanged during the study period.

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