Long-term outcomes of the observe-and-plan regimen in treating neovascular age-related macular degeneration: a retrospective real-life analysis

• Published in: Eye (London) Vol. 39; no. 11; pp. 2188 - 2193
• Main Authors: Sherif, M., Derradji, Y., Safi, A., Mantel, I.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2025; Nature Publishing Group
• Subjects: 13/1; 692/699; 692/699/3161; Acuity; Age; Aged; Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - therapeutic use; Diabetes; Diabetes mellitus; Diabetic retinopathy; Female; Follow-Up Studies; Humans; Intravitreal Injections; Laboratory Medicine; Macular degeneration; Male; Medical imaging; Medicine; Medicine & Public Health; Ophthalmology; Patients; Pharmaceutical Sciences/Technology; Photodynamic therapy; Ranibizumab - administration & dosage; Ranibizumab - therapeutic use; Receptors, Vascular Endothelial Growth Factor - administration & dosage; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - administration & dosage; Recombinant Fusion Proteins - therapeutic use; Retinopathy; Retrospective Studies; Structure-function relationships; Surgery; Surgical Oncology; Tomography, Optical Coherence; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual acuity; Visual Acuity - physiology; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - physiopathology; Germany
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-025-03830-1

Background/Objectives This study aimed to evaluate the long-term (7 years) outcome of visual acuity in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents following the observe-and-plan regimen. Subjects/Methods A total of 195 eyes from 181 patients with nAMD (mean age 79.5 ± 6.9 years), with a mean follow-up duration of 66 ± 37 months, treated with intravitreal anti-VEGF (ranibizumab or aflibercept) were included in this retrospective study. The principles of the observe-and-plan regimen were followed, with follow-up exceeding 3 years in real-life settings. Data collected included visual acuity (VA), number of injections and visits, central retinal thickness, and any complications over 7 years from baseline. Results The mean baseline VA was 63 ± 17 Early Treatment of Diabetic Retinopathy Study letters (Snellen equivalent 20/63), improving to 73 ± 14 at year 1. The initial visual gain was slightly reduced with a final mean VA of 70 ± 18 letters (Snellen equivalent 20/40) at year 7. The mean central macular thickness decreased significantly from 375 ± 129 at baseline to 276 ± 75 at year 1 and to 279 ± 87 at year 7. The mean annual number of injections decreased from 8.7 ± 3.2 in year 1 to 6.7 ± 3.7 in year 2 and to 5.5 ± 2.8 in year 7. The mean annual number of visits remained constant throughout, with 4.1 ± 1.3 visits in year 1 and 4.7 ± 1.7 in year 7. Conclusions The observe-and-plan regimen was very efficient for treating nAMD in real-life settings, reducing the clinical burden on the medical system and patients, with excellent functional and structural long-term results.