Long-Term Treatment Outcomes in Neovascular Age-Related Macular Degeneration

Abstract

Background: Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease and a leading cause of vision loss in older adults. Anti-vascular endothelial growth factor (anti-VEGF) therapy has significantly improved visual outcomes, but long-term efficacy and factors influencing treatment response remain areas of investigation. Understanding these factors can help optimize management strategies.

Aim: This study aims to evaluate the long-term visual and anatomical outcomes of anti-VEGF therapy in patients with nAMD, assess the impact of systemic comorbidities on treatment response, and identify predictors of better visual prognosis.

Methods: A prospective observational study was conducted on 90 patients diagnosed with nAMD at a tertiary ophthalmology center. Data on demographics, visual acuity (logMAR), and central macular thickness (CMT) (µm) were collected at baseline, 6 months, and 12 months. Statistical analysis was performed using SPSS version 23.0, employing paired t-tests, ANOVA, and regression models to evaluate treatment outcomes and influencing factors (p < 0.05 considered significant).

Results: At 12 months, the mean visual acuity improved from 0.72 ± 0.21 logMAR to 0.42 ± 0.18 logMAR (p < 0.001), with 70% (63/90) of patients gaining ?2 lines of vision. The mean CMT reduced from 385.6 ± 45.2 µm to 290.4 ± 38.6 µm (p < 0.001). Patients with hypertension and diabetes mellitus showed lower visual improvement than those without comorbidities. Multivariate regression analysis identified baseline visual acuity, baseline CMT, and the number of anti-VEGF injections as significant predictors of visual improvement. Adverse events were minimal, with 5.5% experiencing mild intraocular inflammation and 7.8% transient intraocular pressure elevation.

Conclusion: Anti-VEGF therapy significantly improves visual acuity and reduces macular thickness in patients with nAMD over 12 months. However, comorbidities such as hypertension and diabetes may negatively affect treatment response. Early intervention, regular monitoring, and adherence to therapy are critical for long-term success.

Recommendations: A personalized treatment approach considering baseline visual acuity, central macular thickness, and systemic comorbidities is essential. Patient education on adherence is crucial to prevent disease recurrence. Future research should explore extended-interval anti-VEGF regimens to reduce treatment burden and investigate combination therapies for better outcomes. Long-term follow-up studies are needed to optimize management strategies.

Keywords: Neovascular age-related macular degeneration, anti-VEGF therapy, visual acuity, central macular thickness, treatment outcomes.