Quantitative assessment of the outcome of anti-vascular endothelial growth factor treatment for neovascular macular degeneration

Neovascular Macular Degeneration is a significant cause of blindness world–wide. Anti-Vascular Endothelial Growth Factor medication injected directly into the eye has halved the disease burden in recent years. Being able to adequately quantify the outcome of neovascular AMD treatment gives perspective not only on appropriate intervention for individual patients, but also the understanding of the science behind the disease, its therapeutics and design of future clinical trials. Assessment tools can be either subjective or objective, and often interrogate either efficacy or safety endpoints. Although patient reported Quality of Life utilities give the ultimate assessment of treatment success for an individual, surrogate biomarkers are more effective in judging short-term response. Visual acuity assessment is useful in analyzing cohorts of individuals, but its subjective nature means that it is not particularly useful in determining individual retreatment decisions. An objective morphological assessment of the macular architecture does provide a good way of assessing short-term response however. Retinal sensitivity also demonstrates usefulness as an endpoint for clinical trials, but as of yet is too cumbersome a technique for high volume clinical work. Functional imaging of the visual cortex remains a research tool at present, but provides promise as a new objective endpoint. Importantly this thesis has confirmed that that cortex is able to regain function after a short period of compromise due to neovascular macular degeneration. Measurement tools to assess the outcome of treatment are best selected, often in composite, with regards to the prime reason for assessment being undertaken.