Data for: “Real World” Outcomes of Anti-Vascular Endothelial Growth Factor Therapy in Neovascular AMD in the United States: The Relationship Between Loss to Follow-up and Visual Outcomes

Published: 01-03-2018| Version 1 | DOI: 10.17632/txfn4vgjvn.1
Thomas Ciulla,
Samir Patel,
Sandi Zaveri,
Forbes Huang,
Keith Westby,
David Williams


“Real World” Outcomes of Anti-Vascular Endothelial Growth Factor Therapy in Neovascular AMD in the United States Purpose: “Real world” visual outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular AMD (nAMD) have been reported in cohorts outside of the United States (U.S.). This study sought to assess the relationship between presenting visual acuity (VA) and visual outcomes, as well as the potential impact of loss to follow-up, in “real world” anti-VEGF treated nAMD patients from the U.S. Design: Retrospective study of aggregated, longitudinal electronic medical records (EMR) from a geographically diverse sample of U.S. retina specialists (Vestrum Health Retina Database, Vestrum Health, LLC). Subjects, Participants, and/or Controls: Inclusion criteria were: a diagnosis of nAMD, no previous treatment, and at least 3 monthly anti-VEGF injections in the first 4 months from diagnosis between January 2011 and July 2013. Methods: To model loss to follow-up, mutually exclusive cohorts of nAMD patients with loss to follow up after specific time points of 6 and 12 months (no follow-up beyond) were compared to a separate cohort of patients who completed 24 months of follow-up, ending prior to July 2015 (n=2,213). Main Outcome Measure: VA outcomes were assessed on each cohort as a whole, with additional stratification by baseline VA. Results: The 6-, 12-, and 24-month cohorts each received a mean of 5.4, 7.3, and 12.1 injections, and showed no change, no change, and mean change of +3.1 letters from baseline (95% confidence interval 1.8 - 4.4, p < 0.01) respectively. When stratified by baseline VA, nearly all groups lose VA at their respective follow-up periods, except for those with baseline VA of 20/200 or worse. Conclusion: “Real world” nAMD patients in the U.S. receive fewer anti-VEGF injections and experience worse visual outcomes compared to patients in randomized clinical trials, consistent with non-U.S. studies. Compared to patients with worse VA at presentation, patients with better VA at presentation tend to be particularly vulnerable to vision loss. Compared to other patients, those ultimately lost to follow-up have worse visual outcomes at, or prior to, their final visit, suggesting that loss to follow-up can lead to overestimation of visual outcomes in clinical studies of nAMD.