Outcomes of Intentionally Suspending Treatment in Eyes with Advanced Neovascular Age-Related Macular Degeneration

Authors

Katherine C. Awh, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Raziyeh Mahmoudzadeh, The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.
Miratoallah Salabati, The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.
Hana A. Mansour, The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.
Joseph Bechay, Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Department of Ophthalmology, USA.
John Magagna, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Carl D. Regillo, The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.
Allen C. Ho, The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.
Sunir J. Garg, The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.
Jason Hsu, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; The Retina Service of Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, PA, USA.. Electronic address: jasonhsu@alumni.princeton.edu.

Document Type

Journal Article

Publication Date

7-28-2023

Journal

American journal of ophthalmology

DOI

10.1016/j.ajo.2023.07.022

Keywords

advanced; anti-vascular endothelial growth factor; low visual acuity; neovascular age related macular degeneration; treatment suspension

Abstract

PURPOSE: To report outcomes of intentionally suspending anti-vascular endothelial growth factor (anti-VEGF) injections in eyes with advanced neovascular age-related macular degeneration (nAMD). DESIGN: Retrospective cohort study. METHODS: Ninety-three patients with nAMD and best available Snellen visual acuity (VA) ≤20/400 in which anti-VEGF treatment was suspended by the treating physician. VA and optical coherence tomography (OCT) characteristics were evaluated to determine visual and anatomical outcomes up to 24 months after treatment suspension. RESULTS: A total of 93 eyes from 93 patients that had received a mean of 16 anti-VEGF injections over a mean (standard deviation, SD) of 962 (562) days were included. Comparing the treatment suspension visit to 24 months later, no significant change in mean (SD) CFT [163 (118, range 19-704) μm vs. 164 (217, range 19-1468), p=0.97], greatest lesion diameter [2547 (1294, range 134-5707) μm vs. 2442 (1158, range 421-5305) μm, p=0.43], greatest lesion thickness [194 (136, 0-618) μm vs. 205 (131, range 0-573) μm, p=0.40], or VA [1.87 (0.37), 20/1482 vs. 1.94 (0.28), 20/1741, p=0.16] was found. In total, 7 (7.5%) eyes restarted treatment after a mean (SD) of 977 (450) days after treatment suspension. CONCLUSIONS: Suspension of anti-VEGF injections in eyes with advanced nAMD and VA ≤20/400 may be reasonable in cases where the treating physician deems additional treatment is unlikely to provide benefit. While the visual and anatomical findings remained stable after treatment suspension in most, a small number restarted anti-VEGF therapy suggesting that eyes should still be monitored for disease progression.

APA Citation

Awh, Katherine C.; Mahmoudzadeh, Raziyeh; Salabati, Miratoallah; Mansour, Hana A.; Bechay, Joseph; Magagna, John; Regillo, Carl D.; Ho, Allen C.; Garg, Sunir J.; and Hsu, Jason, "Outcomes of Intentionally Suspending Treatment in Eyes with Advanced Neovascular Age-Related Macular Degeneration" (2023). GW Authored Works. Paper 3011.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3011

Department

School of Medicine and Health Sciences Resident Works