Anti-VEGF Treatments May Not Benefit Patients With AMD and Non-Neovascular Fluid

It is important to distinguish between neovascular and non-neovascular fluid using optical coherence tomography-angiography (OCT-A) scans for patients with age-related macular degeneration (AMD) in order to avoid unnecessary anti-vascular endothelial growth factor (VEGF) treatments, according to research published in the Canadian Journal of Ophthalmology. Patients with non-neovascular AMD may best be treated with an observe-and-extend regimen, according to the report. 

Researchers conducted a retrospective case series of 9 patients with intermediate AMD (eyes, 10; median age, 71 years; 8 women) who had macular drusen or drusenoid pigment epithelial detachment associated with non-neovascular fluid. Among study participants, 6 individuals (eyes, 6) underwent treatment with anti-VEGF injections. These patients received follow-up for a median 3 months while receiving injections and for 13.5 months while off of the injections. A total of 3 participants (eyes, 4) did not receive anti-VEGF injections and received a median 118 months of follow-up. All participants underwent OCT-A to exclude macular neovascularization. Subretinal fluid was measured to compare the response of patients who received anti-VEGF injections and those who did not. 

According to the report, subretinal fluid thickness levels remained unchanged in both cohorts at follow-up. In total, 6 eyes developed retinal pigment epithelial (RPE) and outer retinal atrophy, with 1 eye developing incomplete RPE and outer retinal atrophy. All eyes examined demonstrated 2 or more OCT biomarkers that predicted atrophy. Overall, 10 eyes exhibited intraretinal hyperreflective foci, 9 eyes had a drusenoid pigment epithelial detachment, 8 eyes had choroidal hyper transmission, 5 eyes had a hyporeflective drusen core, and 4 eyes had acquired vitelliform lesions.

“Distinguishing neovascular versus non-neovascular fluid using multimodal imaging, including OCT angiography, is essential to avoid unnecessary anti-VEGF therapy,” according to the researchers. “An observe-and-extend regimen may be considered in AMD eyes with non-neovascular fluid.”

Study limitations include a retrospective design, small sample size, variable follow-up intervals, and the absence of a control group.