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dc.contributor.authorSadda, SR
dc.contributor.authorGuymer, R
dc.contributor.authorMones, JM
dc.contributor.authorTufail, A
dc.contributor.authorJaffe, GJ
dc.date.accessioned2020-11-27T00:04:14Z
dc.date.available2020-11-27T00:04:14Z
dc.date.issued2020-05-01
dc.identifierpii: S0161-6420(19)32282-1
dc.identifier.citationSadda, S. R., Guymer, R., Mones, J. M., Tufail, A. & Jaffe, G. J. (2020). Anti-Vascular Endothelial Growth Factor Use and Atrophy in Neovascular Age-Related Macular Degeneration Systematic Literature Review and Expert Opinion. OPHTHALMOLOGY, 127 (5), pp.648-659. https://doi.org/10.1016/j.ophtha.2019.11.010.
dc.identifier.issn0161-6420
dc.identifier.urihttp://hdl.handle.net/11343/252336
dc.description.abstractTOPIC: To summarize the rates of atrophy, risk factors, and atrophy-associated visual outcomes in patients with neovascular age-related macular degeneration (nAMD) who received anti-vascular endothelial growth factor (VEGF) treatment for macular neovascularization (MNV). CLINICAL RELEVANCE: Age-related macular degeneration is a leading cause of vision loss worldwide, and VEGF inhibitors are the primary treatment for nAMD. However, atrophy is observed frequently in eyes treated with anti-VEGF therapy, prompting questions regarding a causative role for these therapies in atrophy development. METHODS: PubMed was searched for articles published in the past 5 years (January 1, 2014, through January 10, 2019). Studies including atrophy outcome(s) in patients with age-related macular degeneration who received anti-VEGF treatment were included. Review articles, retrospective studies, case reports or studies, preclinical studies, prevalence data reports, and non-English studies were excluded. Randomization was not required. RESULTS: Overall, 145 studies were identified; 29 publications were included, with cohorts ranging from 8 to 1185 eyes. Imaging methods used to assess atrophy varied across studies. All studies confirmed the occurrence of atrophy, and when available, longitudinal data from the included studies demonstrated an increase in atrophy incidence over time. Key risk factors or phenotypes associated with atrophy were fellow eye atrophy, reticular pseudodrusen, increased injections, and type 3 lesion. In addition, visual acuity loss was noted with foveal atrophy. DISCUSSION: All studies demonstrated that atrophy occurs in the context of MNV treated with anti-VEGF therapy; however, it is not clear whether anti-VEGF treatment is causative of atrophy versus being associated with atrophy development. The included studies were not designed or powered to assess atrophy as a primary outcome. In addition, it is difficult to determine whether prognostic factors directly affect atrophy. Furthermore, patient populations in clinical trials do not necessarily represent real-world patients. Although phenotypes and risk factors may help to identify those at greater risk of atrophy developing, it is important to recognize that adequately treating exudative MNV remains the best option to optimize vision outcomes in patients with nAMD, particularly given the risk of vision loss with undertreatment observed in the real world.
dc.languageEnglish
dc.publisherELSEVIER SCIENCE INC
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
dc.titleAnti-Vascular Endothelial Growth Factor Use and Atrophy in Neovascular Age-Related Macular Degeneration Systematic Literature Review and Expert Opinion
dc.typeJournal Article
dc.identifier.doi10.1016/j.ophtha.2019.11.010
melbourne.affiliation.departmentOphthalmology (Eye & Ear Hospital)
melbourne.source.titleOphthalmology
melbourne.source.volume127
melbourne.source.issue5
melbourne.source.pages648-659
dc.rights.licensecc-by-nc-nd
melbourne.elementsid1438412
melbourne.contributor.authorGuymer, Robyn
dc.identifier.eissn1549-4713
melbourne.accessrightsOpen Access


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