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To test the hypothesis that patients treated for neovascular age related macular degeneration (nAMD) with longer treatment intervals are more likely to persist with treatment.Data were obtained from the prospectively-defined Fight Retinal Blindness! registry. Treatment interval at 2 years was stratified based on the mean treatment interval over the three visits prior to and including the 2-year visit. Rates of non-persistence to follow-up were assessed from 2 to 5 years.Data from 1538 eyes were included. The overall rate of non-persistence was 51% at 5 years. Patients on longer treatment intervals (12-weeks) at 2 years were found to be less persistent to long-term follow-up. These eyes were found to have fewer active disease visits in the first 2 years (40%) than eyes treated at 4-weekly intervals (66%, p 0.001). In the multivariable analysis, better vision at 2 years was associated with a lower risk of non-persistence (hazards ratio [HR] [95% CI]: 0.95 [0.93, 0.97], P 0.001), while longer treatment intervals (HR [95% CI]: 1.31 [0.95, 1.8] and 1.54 [1.15, 2.06] for 12-week and 12-week intervals vs. 4-week intervals, respectively, P = 0.002) and older patients (HR [95% CI]: 1.03 [1.02, 1.04], p 0.001) were at higher risk of non-persistence.We found that patients on longer treatment intervals at 2 years were more likely to be non-persistent with treatment in later years. Reinforcing the need for ongoing treatment is important for patients on longer intervals who may feel complacent or that treatment is no longer effective, particularly if newer, longer lasting agents become widely available.

Background/aimsTo describe baseline characteristics and 12-month outcomes with vascular endothelial growth factor (VEGF) inhibitors of treatment-naïve hemiretinal vein occlusion (HRVO) compared with branch (BRVO) and central (CRVO) variants in routine clinical care.MethodsA database observational study recruited 79 HRVO eyes, 590 BRVO eyes and 344 CRVO eyes that initiated therapy over 10 years. The primary outcome was mean change in visual acuity (VA—letters read on a logarithm of minimal angle of resolution chart) at 12 months. Secondary outcomes included mean change in central subfield thickness (CST), injections and visits.ResultsAt baseline, mean VA in HRVO (53.8) was similar to CRVO (51.9; p=0.40) but lower than BRVO (59.4; p=0.009). HRVO eyes improved to match BRVO eyes from soon after treatment started through 12 months. Mean change in VA was greater in HRVO (+16.4) than both BRVO (+11.4; p=0.006) and CRVO (+8.5; pConclusionsHRVO generally experienced the greatest mean change in VA of the three types of RVO when treated with VEGF inhibitors, ending with similar 12-month VA and CST to BRVO despite starting closer to CRVO. Inclusion of HRVO in BRVO or CRVO cohorts of clinical trials would be expected to proportionally inflate and skew the visual and anatomic outcomes.

Purpose: Treatment regimens using anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) generally aim to dry the neovascular lesion, however recent evidence suggests that some fluid, particularly subretinal fluid (SRFL), may be tolerated. We assessed the relationship between fluid and visual outcomes using real-world data to test this hypothesis. Methods: Treatment-naïve eyes in the Fight Retinal Blindness! registry treated for nAMD from 1st January 2010 to 1st June 2018 were identified. Lesion activity was graded by practitioners as inactive, active (more than SRFL [i.e. had intraretinal fluid]) or active (SRFL only). Eyes were grouped based on their initial activity and their predominant activity status during the 12 months of follow-up. The primary outcome was the 12-month mean change in visual acuity (VA) between lesion activity subgroups. Results: There were 555 eyes eligible for the analysis. Visual outcomes between eyes that were initially active (any fluid) and initially active (SRFL only) were similar (P = 0.233), with slightly higher gains (mean [95% CI]) observed in initially active (more than SRFL only) eyes after multivariable adjustment (5.9 [4.4, 7.4] vs. 5.0 [2.3, 7.7] letters). However, mean baseline and final VA were worse in eyes that were initially active with more than SRFL only than in eyes with SRFL only (56.0 vs. 63.6 letters at baseline; P < 0.001 and 61.7 vs. 67.5 letters at 12 months; P = 0.002). There was a significant difference in visual outcomes over 12 months between the 3 predominant activity groups (P = 0.010). Predominantly inactive eyes gained the most mean (95% CI) VA at 12 months (7.2 [4.8, 9.6] letters), followed by predominantly SRFL only (7.0 [2.3, 4.7] letters), with predominantly any fluid eyes performing the worst (3.6 [2.1, 5.6] letters) after multivariable adjustment (Figure 1). Conclusions: Eyes that were predominantly active with more than SRFL only had worse outcomes than eyes that were predominantly inactive or active with SRFL only. The presence of SRFL did not appear to have a detrimental effect on 12-month outcomes.