Background: To describe 10-year trends in visual outcomes, anatomical outcomes, and treatment burden of patients receiving anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (nAMD).

Methods: Retrospective cohort study of treatment-naïve, first-affected eyes with nAMD started on ranibizumab before January 1, 2009. The primary outcome was time to best-corrected visual acuity (BCVA) falling ≤ 35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters after initiating anti-VEGF therapy. Secondary outcomes included time to BCVA reaching ≥ 70 letters; proportion of eyes with BCVA ≥ 70 and ≤ 35 letters at 10 years; mean trend of BCVA and central retinal thickness (CRT) over 10 years; and mean number of injections.

Results: For our cohort of 103 patients, Kaplan-Meier analyses demonstrated median time to BCVA reaching ≤35 and ≥70 letters were 37.8 (95% CI 22.2-65.1) and 8.3 (95% CI 4.8-20.9) months after commencing anti-VEGF therapy, respectively. At the final follow-up, BCVA was ≤35 letters and ≥70 letters in 41.1% and 21%, respectively, in first-affected eyes, whilst this was the case for 5.4% and 48.2%, respectively, in a patient’s better-seeing eye. Mean injection number was 37.0 ± 24.2 per eye and 53.6 ± 30.1 at patient-level (63.1% of patients required injections in both eyes). 

Conclusions: The chronicity of nAMD disease and its management highlights the importance of long-term visual prognosis. Our analyses suggest that one in five patients will retain good vision (BCVA ≥70 ETDRS letters) in the first-affected eye at 10 years after starting anti-VEGF treatment; yet one in two patients will have good vision in their better-seeing eye. Moreover, our data suggest that early treatment of nAMD is associated with better visual outcomes.

Depersonalisation was carried out through hash function anonymisation of patient identification numbers, replacement of appointment dates with follow-up days to baseline. Age is not provided as a continuous variable as in original analysis to facilitate deidentification. The database is also comprehensive of lost to follow up patients' data. Approval of adequate depersonalisation was obtained by Moorfields Information Governance.

Moorfields_AMD_Database_10_years, the ReadMe file (Moorfields_AMD_Database_10_years_readme), and the related codes (anon_annualoutcomes and anon_survivalcurve) are provided.