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Five-year AMD treat and extend regimen study suggests it can prevent long-term vision loss

Long-term vision loss from neovascular age-related macular degeneration (nAMD) can be prevented through a treat and extend regimen (TER) of anti-VEGF intravitreal injections, study results have shown.

According to lead researcher Professor Polona Jaki Mekjavic from the Eye Hospital University Medical Centre at the University of Ljubljana, the research also suggests TER can maintain visual acuity levels that allow patients to be self-sufficient in real-world scenarios, such as driving, reading, and recognising faces.

The study examined the long-term efficacy of anti-VEGF treatment using TER in nAMD patients and identified the percentage of patients who experienced adequate visual acuity for independent functioning after treatment.

“The strength of our study is that it assessed long-term visual outcomes of anti-VEGF agents in a real-world setting,” the study authors said.

"The strength of our study is that it assessed long-term visual outcomes of anti-VEGF agents in a real-world setting."
Polona Jaki Mekjavic, Ophthalmologist and professor at the Eye Hospital University Medical Center

“All patients were treatment naïve, and all were treated with the TER regimen. They received treatment from clinical practice in a single eye centre. This allowed us to have the same recommendations for starting treatment, the same method for measuring VA, and the same management criteria.”

The retrospective, single-centre study evaluated 101 nAMD patients using TER over the course of five years. Twenty-five men and 76 women aged 66–97 years took part in the study.

Their best-corrected visual acuity (BVCA) was measured at baseline, using Early Treatment Diabetic Retinopathy Scale (ETDRS) letters, with baseline mean at 60.5 ±11.3. They were then measured once per year thereafter.

The participants received monthly treatment injections of ranibizumab (0.5 mg/0.05 mL), bevacizumab (1.25 mg/0.05 mL) or aflibercept (2 mg/0.05 mL).

Monthly injections continued until the patients exhibited no further signs of choroidal neovascularisation (CNV). If there was no CNV detected, the treatment interval was extended in two-week intervals up to 14 weeks.

If CNV activity continued, the treatment interval was shortened by two weeks.

According to Mekjavic, the patients experienced improvement in visual acuity after one year of treatment, to 67.3 ±10.6 (P <.05).

Over the next four years, visual acuity declined, but still significantly improved over baseline (second year, 66.4 ±11.7; P <.05; third year, 64.5 ±11.7; P <.05; fourth year, 61.4 ±13.0; non-significant). During the fifth year, visual acuity returned to near-baseline levels (58.6 ±18.3).

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