Impact of Treating Age-Related Macular Degeneration before Visual Function Is Impaired

Visual outcomes of age-related macular degeneration (AMD) have substantially improved via anti-vascular endothelial growth factor (anti-VEGF) therapy. However, the treatment effects vary among individuals. Medical charts of 104 eyes (104 patients) with AMD, treated with anti-VEGF drugs and followed up for 12-36 months, were retrospectively analyzed. Logistic regression analyses adjusted for age showed that eyes with an initial best-corrected visual acuity (BCVA) < 0.3 in the logarithm of the minimum angle of resolution (logMAR) were a positive predictor (odds ratio = 3.172; 95% confidence interval [CI] = 1.029-9.783; p = 0.045), and the presence of initial fibrovascular pigment epithelial detachment (PED) was a negative predictor (0.222; 0.078-0.637; p = 0.005) of maintained or improved BCVA at the final visit. Kaplan-Meier survival analysis showed that eyes with an initial BCVA < 0.3 (Cox hazard ratio = 2.947; 95% CI = 1.047-8.289; p = 0.041) had a better survival rate after adjusting for age when failure was defined as a BCVA reduction >= 0.2 of logMAR. Eyes with an initial BCVA < 0.3 belonged to younger patients; more frequently had subretinal fluid as an exudative change; and less frequently had intraretinal fluid, submacular hemorrhage, and fibrovascular PED. Initiating anti-VEGF treatment before BCVA declines and advanced lesions develop would afford better visual outcomes for AMD eyes in the real-world clinic, although further analyses are required.