Neovascular age-related macular degeneration (nAMD) could lead to rapid vision loss among the elderly, but new research indicates improved treatment strategies are within reach.
A study conducted by Gyeongsoo Lim and his colleagues at Chungbuk National University Hospital aims to optimize treatment for this leading cause of vision impairment by focusing on early optical coherence tomography (OCT) biomarkers and best-corrected visual acuity (BCVA) as predictors of treatment needs. Intravitreal injections of aflibercept, commonly used to manage nAMD, show varying responses among patients, making standard treatment regimens challenging.
The research, reported as part of the wider trend toward personalized medicine, analyzed 101 consecutive nAMD patients treated with aflibercept between December 2016 and March 2020. Each patient received three monthly loading doses before transitioning to a treat-and-extend (T&E) regimen adjusted based on their disease activity.
Significantly, the study found post-loading central subfield thickness (CST) as the most reliable predictor for how often patients would need injections over one year. Findings indicated CST post-loading accurately reflected both injection frequency (p < 0.001) and the timing of recurrence after treatment (p = 0.013). Interestingly, baseline CST and BCVA presented no correlation with these factors, reinforcing the notion of tracking early treatment response as pivotal for guiding future therapy.
“CST after the loading phase is a reliable predictor of treatment needs within one year, superior to baseline biomarkers,” wrote the authors of the article. This insight directs attention toward timely adjustments to treatment protocols, emphasizing the need for clinical vigilance during this initial period.
The T&E approach, which allows for extending the interval between injections based on active disease monitoring, helps mitigate the burden on patients. According to the findings, patients fall within two categories virtually based on their treatment needs. The high-treatment-need group (HTNG) typically required more frequent injections, experiencing recurrence and T&E initiation within eight weeks after loading, whereas the low-treatment-need group (LTNG) maintained stability without needing treatment until three months or longer.
With 51 eyes exhibiting type 1 macular neovascularization (MNV) and 52 type 2 MNV, the study showed clear differences between the rapid response of type 2 neovascularization and the slower potential of type 1. “Type 2 macular neovascularization responded more rapidly to treatment than type 1, reflecting varying dynamics,” the authors noted. This distinction is significant since it can help clinicians tailor therapy more effectively according to the specific characteristics of the neovascular disease present.
The average BCVA of patients at the start of the study measured 0.61 logMAR, with most patients requiring around 5.8 injections over the year. Despite the differences observed among treatment groups, BCVA remained fairly stable during the study, regardless of their treatment frequency. "BCVA remained similar between high- and low-treatment-need groups... reflecting varying dynamics," the authors indicated, underlining the complexity of nAMD’s progression versus treatment response.
Such findings advocate strongly for monitoring early OCT responses to guide treatment decisions actively. While conventional fixed schedules may be beneficial, they do not account for individual patient variability, leading to overtreatment or the risk of vision loss due to delayed responses.
“Early response monitoring during loading enables personalized anti-VEGF therapy, minimizing overtreatment and preserving vision,” wrote the authors of the article. Emphasizing how central subfield thickness changes should inform treatment adjustments can usher in new protocols focused on results and patient needs.
Although limitations such as the study's retrospective nature and exclusive use of aflibercept need to be considered, the findings provide valuable contributions to the dialogue around personalized treatment strategies for nAMD. Future studies could compare outcomes across different anti-VEGF therapies and involve longer follow-up periods to understand broader trends.
Overall, this study heralds significant progress toward fine-tuning treatment regimens for nAMD, providing hope for improved patient outcomes through individualized management based on anatomical responses observed during early treatment phases.