Table 1 Studies on impact of anti-VEGF treatments on vision-related outcomes
Study | Country/region | Study design | Outcomes measure(s)/definition | Key finding(s) |
|---|---|---|---|---|
Bloch et al. [12] | Denmark | Population-based study | BCVA ≤0.1 (20/200) in both eyes; tunnel vision defined as constriction to ≤5 degrees eccentricity or homonymous hemianopia | The incidence rate of legal blindness attributable to AMD in citizens aged > 50 years decreased from 52.2 cases per year per 100,000 in 2000 to 25.7 cases per year per 100,000 in 2010 (50% reduction) |
Borooah et al. [15] | Scotland | Population-based study | Blindness (severe sight impairment) defined as: • Snellen VA of < 3/60 with a full visual field • VA between 3/60 and 6/60 with a severe reduction of field of vision (e.g. tunnel vision), or • VA of ≥6/60 but with a very reduced field of vision with their better eye | Incidence of legal blindness due to nAMD per 100,000 population (age-sex standardized): • 2004: 8.5 • 2005: 8.6 • 2006: 9.1 • 2007: 8.8 • 2008: 7.1 • 2009: 6.8 • 2010: 4.9 • 2011: 4.8 Following the introduction of IVTR there were annual decreases in the incidence of blindness. Cases fell to a trough of 4.8/100,000 in 2011 in either eye (drop of 47%) |
Bressler et al. [16] | US | Simulation-based study | Legal blindness was defined as VA ≤38 ETDRS letters (comparable to a Snellen equivalent of 20/200) in the better-seeing eye | In case of no treatment, 16,268 individuals would become legally blind over 2 years. The treatment reduced the number of cases of legal blindness by 72% to 4484 individuals. |
Campbell et al. [17] (abstract) | US | Cohort-based study | Legally blind, VA 20/200 in better-seeing eye; eyes with incident nAMD and ≥ 12 months of follow-up; two cohorts of patients that are selected to have one cohort before and one after the advent of anti-VEGF therapy | In 2002 (n = 84), prevalence of visual impairment (2 years) • 29% (95% CI, 19–39) In 2008 (n = 41), prevalence of visual impairment (2 years) • 2% (95% CI, 0–13) Reduction in odds (2002–2008); 95% CI, 59–100 |
Johnston et al. [13] | UK | Cohort-based study | VA ≤38 ETDRS letters in the better-seeing eye | Percentage of blindness described in the study • 2008: 6.9% • 2009: 3.9% • 2010: 2.0% • 2011: 2.4% Cumulative incidence of new blindness at follow-up, with significant reductions in the rates between year cohorts • At 1 year: 5.1% • At 2 years: 8.6% • At 3 years: 12.0% • At 4 years: 15.6% |
Keenan et al. [18] | UK | Cohort-based study | 0–24 letters correspond to eligibility for full CVI; 25–39 letters to eligibility for partial CVI | The proportion of patients in the study eligible at baseline for full or partial CVI decreased from 13.8% in 2008 to 7.1% in 2012 (P = 0.04). |
Minassian et al. [19] | UK | Simulation-based study | Blindness defined as VA of < 6/60 in the better seeing eye | Blindness was expected to increase from 90,254 in 2010 to 120,452 in 2020, assuming that 75% of those eligible patients are treated with the approved anti-VEGF |
Mitchell et al. [20] | Australia | Simulation-based study | BCVA < 6/60 (approximate ETDRS letter score ≤ 38) in the better-seeing eye | Without treatment, 2246 individuals would become legally blind over 2 years. With treatment, the incidence of blindness was reduced by 68–72% |
Rostron et al. [21] | UK | Population-based study | Sight impairment and severe visual impairment used on the UK certificate of visual impairment & incidence of visual impairment certification due to AMDa | After the introduction of ranibizumab in 2008, the incidence of visual impairment certification due to nAMD dropped from 225 per million population in 2005 to 137 per million in 2010 after 2008 |
Skaat et al. [22] | Israel | Population-based study | BCVA of < 1/60 or central visual field ≤10 degrees in the less impaired eye; incidence of certified blind population in Israel due to AMD and other causes | The incidence of newly registered legal blindness at the end of the studied decade was half that at the beginning, declining from 33.8 per 100,000 population in 1999 to 16.6 per 100,000 population in 2008 |
Sloan et al. [23] | US | Cohort-based study | Sight impairment based on the ICD-9-CM codes for severe vision loss and blindness decrease in vision, vision loss/blindness | Vision loss or blindness was 2.04% in the 2 years following a first exudative AMD diagnosis; the introduction of anti-VEGF therapy reduced vision loss or blindness by 46% (OR, 0.54; 95% CI, 0.47–0.63) |