Longer-term outcomes of intravitreal therapy for neovascular age-related macular degeneration at a peripheral centre (Palmerston North eye clinic).
TL;DR
High early cessation due to end-stage disease suggests possible late presentation, underscoring the need for earlier detection and referral in neovascular age-related macular degeneration patients.
Abstract
Aim
The aim of this study was to evaluate long-term real-world outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) at a regional New Zealand centre, with a primary focus on treatment duration and reasons for cessation.
Methods
A retrospective cohort study was conducted at Palmerston North eye clinic, including all newly diagnosed eyes with nAMD initiating anti-VEGF therapy between November 2017 and August 2023. Demographic data, visual acuity, treatment duration and documented reasons for cessation were extracted from a prospectively maintained database and validated against electronic health records.
Results
Among 527 eyes from 446 patients, 39.8% ceased treatment. The most common reasons were end-stage disease (44.8%), patient death (21.9%), logistical factors (17.6%) and injection intolerance (8.1%). Mean treatment duration was 421 days. Visual outcomes were favourable overall with 20.2% of eyes improving and 59.5% remaining stable. Better baseline visual acuity strongly predicted better final vision.
Conclusions
High early cessation due to end-stage disease suggests possible late presentation, underscoring the need for earlier detection and referral. Addressing logistical barriers and supporting adherence will be increasingly important as demand for anti-VEGF therapy grows with an ageing population.