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Updated: Dec 7, 2025
Author Spotlight: Overcoming Anti-VEGF Resistance Through Advanced Vascular Morphology Assessment in Choroidal Neovascularization
Published on: August 11, 2023
Long-term Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: The
Kimberly Spooner1, Samantha Fraser-Bell2, Thomas Hong1
1Sydney Retina, Sydney, New South Wales, Australia.
Purpose:
To report the 10-year outcomes of eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors.
Design:
Ten-year, retrospective cohort study.
Participants:
A total of 1046 patients who commenced treatment with anti-VEGF for nAMD.
Methods:
Anti-VEGF-naïve eyes diagnosed with nAMD that commenced treatment between November 2006 and December 2009 were identified. Data collected included the baseline demographics, visual acuity (VA), and number of intravitreal injections. Baseline fundus fluorescein angiograms and OCT images were graded for choroidal neovascularization type. OCT images were graded for central macular thickness (CMT) and the presence of fluid over the 10 years.
Main Outcome Measures:
Change in vision at 10 years. Secondary outcomes included the proportion of eyes with 20/40 vision or better and 20/200 or worse, the proportion of eyes that were dry on OCT imaging, and the number of injections.
Results:
Of 1046 eligible eyes, 10-year data were available for 293 (28%), which were included in the analyses. Eyes received 58.1 (standard deviation [SD], 33.6) injections during the 10 years. The mean CMT decreased from 355.5 μm (SD, 107.8 μm) to 264.2 (SD, 79.5) μm (P < 0.001). The median baseline VA was 60 (interquartile range [IQR], 45-70) letters, which improved by 9 (IQR, 1-14) letters after the first year of treatment (P < 0.001). Over the 10-year period, these initial gains were lost over time with a final VA change of +3 letters (IQR, 8-10 letters, P = 0.162). However, the proportion of eyes with VA 20/40 or better increased from 29% at baseline to 35% at 10 years (P < 0.001). The proportion of eyes at baseline with VA 20/200 or worse was 14% and 17% at 10 years.
Conclusions:
On average, eyes with nAMD maintained starting VA when treated with VEGF inhibitors for 10 years. With ongoing regular treatment, a greater proportion of eyes achieved VA of 20/40 or better at 10 years than at presentation.
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