Assessment of Functional Success Predictors in the Treatment of Exudative AMD: A 3-Year Real-World Study

INTRODUCTION: Intravitreal anti-VEGF therapy has been shown to delay progression of neovascular age-related macular degeneration (nAMD) and reduce the incidence of legal blindness. However, a subset of patients exhibits suboptimal responses, with some experiencing significant vision loss. The underlying causes of this variability remain for the most part unclear. Retrospective studies have so far identified potential predictors of visual outcomes. This study aimed to investigate factors associated with functional success in treatment-naïve nAMD patients receiving anti-VEGF therapy over a 3-year period. METHODS: A retrospective observational study was conducted at a tertiary center in Coimbra (Portugal), including naïve patients who started treatment with anti-VEGF for nAMD between 2017 and 2020 and completed a 3-year follow-up period. Demographics, best corrected visual acuity (BCVA), time until treatment initiation and OCT features were evaluated. Functional success was defined as achieving driving vision (>69 letters) in 3 years. The effects of baseline clinical and OCT markers on functional success were analyzed at last follow-up using mixed-effects models. RESULTS: One hundred fourteen eyes from 89 patients were included, of which 56.2% were female. Mean age at inclusion was 76.82 (7.23) years. Thirty-nine eyes (34.2%) achieved functional success at last follow-up. Overall, a significant decrease of mean 5.75 (2.15) letters in BCVA was observed during follow-up, from mean 56.98 (95% CI: 52.7, 61.3) at baseline to 51.23 (95% CI: 46.9, 55.6) letters at 3 years (p=0.009). A mixed-effects model was used to identify predictors of functional success at 3 years. Higher BCVA at baseline predicted a 1.06 (95% CI: 1.03, 1.09) higher odds of achieving functional success. Similarly, the presence of subretinal fluid at baseline had a 4.20 (95% CI: 1.12, 15.69) higher odds of functional success at 3 years. On the other hand, the presence of type 2 neovascularization was associated with a 0.15 (95% CI: 0.03, 0.90) lower odds of achieving functional success. CONCLUSION: In this study, BCVA and the presence of subretinal fluid at baseline were significant predictors of functional success. Careful evaluation of clinical and OCT features at baseline may enable better prognostic assessments for patients with neovascular AMD treated with anti-VEGF.