Macular Atrophy Affecting Visual Outcomes in Patients Undergoing Anti-VEGF Treatment in Routine Clinical Practice

BACKGROUND AND OBJECTIVE: To explore how baseline macular atrophy (MA) affects visual acuity (VA) in patients receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections for neovascular age-related macular degeneration (nAMD). PATIENTS AND METHODS: A retrospective, case control series. Patients were grouped into three cohorts based on baseline spectral-domain optical coherence tomography image findings: foveal MA, nonfoveal MA, and no MA. Outcomes were assessed at 1, 2, and 3 years following anti-VEGF therapy. RESULTS: No differences existed in MA growth between eyes with foveal and nonfoveal MA (0.89 mm 2 [95% confidence interval (CI), 0.64–1.14] vs. 0.88 mm 2 [95% CI, 0.72–1.05]) after adjusting for baseline lesion sizes at 3 years. Foveal MA patients lost an average of 19.4 ETDRS letters (95% CI, −30.8 to −8.0) after 3 years. Nonfoveal MA patients gained an average of 1.1 ETDRS letters (95% CI, −6.8 to 9.0), and patients without MA averaged a gain of 9.7 ETDRS letters (95% CI, 5.5–14.0). CONCLUSION: In patients with nAMD receiving anti-VEGF in routine clinical practice, presence of baseline foveal MA was associated with significant vision loss. [ Ophthalmic Surg Lasers Imaging Retina. 2020;51:68–75.]