LAUSR

Abstract Purpose To analyze best-corrected visual acuity (BCVA) outcomes after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD). Design Prospective cohort study of participants enrolled in a clinical trial of oral supplements and receiving anti-VEGF therapy in routine clinical practice. Participants Age-Related Eye Disease Study 2 (AREDS2) participants (50-85 years) whose eyes met AREDS2 inclusion criteria at baseline (no late AMD; BCVA ≥20/100; no previous anti-VEGF injections) but received at least one anti-VEGF injection for incident neovascular AMD during follow-up. Methods Participants underwent refracted BCVA testing, ophthalmoscopic examination, and stereoscopic color fundus photography at baseline and annual study visits over 5 years. Self-reports of anti-VEGF injections (numbers, dates, and names of drug) were collected at baseline and annual study visits, and at 6-monthly telephone calls. Main outcome measures The primary outcome measures were mean refracted BCVA and the proportions of eyes with BCVA ≥20/40 and ≤20/200. An exploratory outcome measure was the mean number of self-reported anti-VEGF injections. Results 1105 eyes of 986 AREDS2 participants met the inclusion criteria; of these, 977 participants (99.1%) had at least one post-treatment visit. At the first and subsequent annual study visits after the first injection, mean refracted BCVAs were 68.0 letters (20/40), 66.1, 64.7, 63.2, and 61.5 (20/60). The proportions of eyes with BCVA ≥20/40 were 59.3%, 55.1%, 53.5%, 50.6%, and 49.7%, and those with BCVA ≤20/200 were 5.5%, 8.6%, 9.4%, 12.4%, and 14.4%. The mean annual numbers of self-reported anti-VEGF injections per eye were 2.9, 3.9, 3.3, 3.1, and 3.0. Conclusions Refracted BCVA data were obtained in a clinical trial environment but related to anti-VEGF treatment given in normal clinical practice. Visual outcomes declined slowly with increased follow-up time: mean BCVA decreased by approximately 1.5-2 letters per year. At five years, half of eyes achieved BCVA ≥20/40 but approximately one sixth were ≤20/200. These data may be useful in assessing the long-term effects of anti-VEGF therapy.