Nonpersistence in Anti-VEGF Treatment Linked to Poorer Visual Outcomes in Wet AMD

A real-world analysis of 201,766 eyes shows that patients with wet age-related macular degeneration (AMD) face increased rates of undertreatment and treatment attrition over time. According to a study presented at the Association for Research in Vision and Ophthalmology meeting, these gaps in anti-VEGF injections result in worse long-term visual outcomes for patients.

Why are anti-VEGF treatment rates declining?

Attrition is most severe in the early stages of care. Data from a retrospective analysis of the Vestrum Health database shows that 38.9% of eyes failed to continue treatment by year one, and that number rose to 52.6% by year two, according to lead author Andrew A. Moshfeghi, MD, MBA.

Treatment frequency also dropped steadily over a seven-year follow-up period. The mean number of annual injections fell from 8.4 in the first year to 6.2 by the seventh year, the researchers found.

Did You Know? In this study, researchers defined “nonpersistence” as a treatment gap lasting more than 180 days.

What factors lead to poor visual outcomes?

Several clinical factors are linked to delays in starting treatment or decreased vision improvements. According to the poster presented in Denver, atrophy, fibrosis, and poor visual acuity at baseline were associated with treatment delays of 30 days or more during the first year.

The study also found that vitreous hemorrhage and fibrosis were associated with decreased vision improvements. Interestingly, a high frequency of treatment was linked to a greater likelihood of patients stopping therapy entirely.

Expert Insight: Samantha Carter notes that the link between high treatment frequency and nonpersistence suggests a difficult trade-off for patients. While frequent injections are intended to preserve sight, the burden of those visits may actually drive patients to abandon care, ultimately risking the very vision the treatment aims to save.

How could treatment approaches change?

While both treated and untreated groups experienced gradual vision loss, those who remained persistent with their regimen had better long-term outcomes. This disparity suggests that current “episodic treatment bursts” may wane in effect too quickly, Moshfeghi told Healio.

Future care may shift toward longer-lasting treatment approaches. Such methods could leverage continuous exposure to intraocular therapies to reduce the attrition rates seen in the first two years of treatment.

Frequently Asked Questions

What is the definition of nonpersistence in wet AMD treatment?
Nonpersistence is defined as a treatment gap of more than 180 days.

When do most patients stop their anti-VEGF injections?
The most significant attrition occurs within the first two years, with 52.6% of eyes failing to continue treatment by the second year.

What factors are associated with decreased vision improvements?
According to the study, delayed treatment initiation, fibrosis, and vitreous hemorrhage were associated with decreased vision improvements.

Do you believe longer-lasting therapies would improve patient adherence to vision-saving treatments?