Long-term visual outcomes of patients with neovascular age-related macular degeneration treated with anti-VEGF therapy lost to follow-up

초록

Purpose: To evaluate the long-term visual outcomes of patients with neovascular age-related macular degeneration (AMD) who were lost to follow-up (LTFU) during treatment compared with those with continuous follow-up (CFU). Methods: A retrospective study was conducted on patients diagnosed with neovascular AMD who received anti-VEGF therapy from 2010 to 2022. The patients were classified into the long-term LTFU group (LTFU for more than 6 months), the short-term LTFU group (LTFU for 2 months to less than 6 months), and the CFU group. We conducted a comparative analysis of baseline characteristics, factors related to visual prognosis, and differences in the occurrence of severe vision loss. Results: A total of 169 patients were classified into 43 in the long-term LTFU group, 57 in the short-term LTFU group, and 69 in the CFU group. The mean follow-up duration was 57.12 ± 31.68 months. There was no significant difference in baseline visual acuity (logMAR) among the long-term LTFU, short-term LTFU, and CFU groups (0.76 ± 0.54, 0.68 ± 0.51, and 0.72 ± 0.54, respectively; P = 0.734). The final visual acuity was significantly lower in the long-term LTFU group (1.12 ± 0.79) compared with the short-term LTFU group (0.65 ± 0.62) and the CFU group (0.65 ± 0.56) (P < 0.001), and the change in visual acuity was significantly greater in the long-term LTFU group (0.36 ± 0.69) compared with the short-term LTFU group (-0.03 ± 0.64) and the CFU group (-0.07 ± 0.58) (P = 0.001). Long-term LTFU was significantly associated with changes in visual acuity from the baseline to the final visit (P = 0.002) and severe vision loss (P = 0.002). Conclusion: In patients with neovascular AMD, those LTFU for more than six months during treatment had worse long-term visual outcomes compared to those with regular follow-up or shorter LTFU durations. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.; What is known : Key messages: Unlike systemized clinical trials, loss to follow-up can occur during the treatment of age-related macular degeneration in the real world. Loss to follow-up during the treatment of age-related macular degeneration is known to result in poor short-term prognosis, even if treatment is resumed. What is new : During the approximately 5-year follow-up period, patients who experienced more than 6 months of loss to follow-up during neovascular AMD treatment did not regain their previous visual acuity, even after resuming treatment. Loss to follow-up of more than 6 months was associated with severe vision loss of more than three lines and worse long-term visual outcomes compared to those who continued regular follow-ups. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.

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