Incidence and risk factors of visual impairment in patients with angioid streaks and macular neovascularization

Abstract

OBJECTIVE

To estimate the incidence and risk factors of visual impairment and complications in eyes with macular neovascularization (MNV) due to angioid streaks (AS).

DESIGN

Longitudinal multicenter retrospective cohort study.

SUBJECTS

Patients with AS-associated MNV treated with anti-vascular endothelial growth factor (VEGF) agents and a follow-up >3 months.

METHODS

Clinical and MNV characteristics were collected at baseline. Visual acuity (VA) values and presence of atrophy or fibrosis were collected at each visit.

MAIN OUTCOME MEASURES

Rate of VA change over time and associated factors. Incidence rate of moderate to severe visual impairment (MSVI) and blindness and hazard ratio (HR) of candidate risk factors for MSVI. Incidence rate of fibrosis and macular atrophy.

RESULTS

84 eyes of 66 patients (39 males, 58%) with mean[standard deviation, SD] age 55.7[13.8] years were followed for a mean[SD] of 67.7[48.5] months. Median number of anti-VEGF doses per eye was 13. Average rate[95%confidence interval, CI] of visual loss was +0.04[0.02-0.06] LogMAR/year (p<0.001); visual loss was faster in non-naïve eyes (p=0.007) and those with better baseline VA (p<0.001); it was slower in eyes with pattern dystrophy-like features (p=0.04). Incidence rate[95% CI] of MSVI and blindness were 10.4[6.88-15]/100-eye-years and 2.33[1.12-4.29]/100-eye-years. A higher number of injections (HR[95% CI] =0.45[0.19-0.94] for receiving ≥13 injections vs. <13, p=0.03) was protective against MSVI. Incidence rates[95% CI] of fibrosis and macular atrophy were 24.1[17.5-32.3]/100-eye-years and 14.3[10.1-19.6]/100-eye-years.

CONCLUSION

Eyes with MNV-related AS had a high rate of visual impairment and propensity to macular fibrosis and atrophy. A higher number of injections yielded better chances of maintaining good visual acuity, suggesting the need for intensive treatment.