The impact of disease activity on 5-year outcomes in patients undergoing treatment for neovascular age-related macular degeneration

Purpose: To assess the impact of disease activity on clinical outcomes in a “real-world” cohort with neovascular age related macular degeneration (nAMD) over 5 years.

Methods: Data were obtained from the prospectively-defined Fight Retinal Blindness! registry. Eyes were divided into tertiles based on the proportion of visits where choroidal neovascular lesion was active (low, moderate and high) up until 5 years.

Results: Data from 2109 eyes were included. The adjusted mean (95% CI) VA change was -0.5 letters (-1.8, 1.1), 1.8 letters (0.2, 3.4) and -2.5 letters (-4.2, -1.3) in the low, moderate and high activity groups respectively, p<0.001. Eyes in the low activity group were more likely to develop macular atrophy (56%, 47% and 26% in the low, moderate and high activity groups respectively, p<0.001) but less likely to develop subretinal fibrosis (27%, 35% and 42% in the low, moderate and high activity groups respectively, p<0.001). Conclusions: Eyes with higher and lower levels of disease activity had poorer outcomes than eyes with moderate activity over 5 years, apparently due to the development of subretinal fibrosis or macular atrophy.