Real-World Outcomes in Neovascular AMD with Visit Gaps under Anti-VEGF Therapy: Data from the FRB! Registry

To evaluate visual outcomes observed across visit gaps in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) therapy in routine clinical practice. Retrospective data analysis from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! (FRB!). Treatment-naïve nAMD eyes receiving intravitreal anti-VEGF therapy (≥1 injection), monitored at least quarterly during the first treatment year, and experiencing a visit gap of ≥6 to 12 months, with subsequent follow-up over the next 9 months (≥3 visits). Visual outcomes were assessed using a segmented linear mixed-effect model. Cumulative incidence and risk factors for visit gaps were evaluated using Aalen-Johansen estimators and Cox regression models. The main outcome was the mean estimated change in VA immediately after the visit gap. Secondary outcomes included the cumulative incidence and associated risk factors of visit gaps. From 3694 eligible eyes for the survival analysis, we tracked 262 (7.1%) eligible eyes experiencing a visit gap for the visual outcome analysis. nAMD-treated eyes experiencing a 6-12 month visit gap had a significant drop in vision immediately after the visit gap, with a mean (95% confidence interval CI) estimated change in VA of -4.9 letters (-6.0 to -3.7; P < 0.001). Eyes with active choroidal neovascularization (CNV) lesions (difference -3.9 -7.1 to -0.3 letters vs. inactive CNV) and without subfoveal macular atrophy (MA) (difference 3.4 -0.3 to 7.0 letters vs. subfoveal MA) at the last visit before the gap experienced a greater decline in VA after the visit gap. A quarter of the eyes experienced a 6-12 month visit gap at 6.5 years. nAMD eyes with a longer time interval since last injection were more likely to experience a visit gap, while eyes with better VA and that had active CNV with subretinal fluid only at follow-up visits were less likely. Visit gaps were common and associated with a significant visual decline across the visit gap in nAMD eyes treated with anti-VEGF therapy in routine clinical practice.