Impact of delayed appointments on treatment outcomes in neovascular macular degeneration

Abstract

Purpose: To evaluate the real-world visual outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy, the frequency of delayed appointments and the relationship between delays and visual outcomes in patients with neovascular age-related macular degeneration (nAMD). Methods: This single-centre retrospective study included a cohort of 3831 treatment-naïve nAMD patients who were treated with bevacizumab monotherapy using a pro re nata protocol between 2008 and 2023, comprising a total of 79 545 visits. Visual acuity (VA) was measured at the time of diagnosis and during follow-up visits and was converted into Early Treatment Diabetic Retinopathy Study letters. One eye per patient was included in the analysis. Delayed visits were categorised as >6 weeks and ≤8 weeks, >8 weeks and ≤ 10 weeks and >10 weeks. Results: After an initial stabilisation in VA during the first treatment year, VA started to decline. The proportion of visits delayed >6 weeks varied between 24% and 36% per treatment year, with delays being more common during the early years of the study when the new therapies were introduced. In general, the decline in VA was more severe with a higher number and longer duration of delayed visits. Conclusions: Delays in anti-VEGF injections are common and strongly associated with vision loss. Therefore, it is important to improve patient awareness and compliance. Use of new longer-acting therapies may support this process.