Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration

Robert P. Finger, Sanjeewa Wickremasinghe, Paul N Baird, Robyn H. Guymer

Research output: Contribution to journalReview ArticleResearchpeer-review

73 Citations (Scopus)

Abstract

Currently available evidence on predictors of anti-vascular endothelial growth factor (VEGF) treatment response in neovascular age-related macular degeneration was reviewed. No meta-analysis of results is possible because of a lack of controlled and randomized trials, varying treatment regimes and outcome measures used, as well as suboptimal reporting. For genetic factors, most evidence to date has been generated for single nucleotide polymorphisms (SNPs) in the complement factor H (CFH), and VEGF-A genes. Just under half of the SNPs assessed in the CFH gene and 15% of the SNPs assessed in the VEGF gene were found to be associated with visual outcomes or the number of injections required during follow-up. Some evidence suggests association of worse treatment outcomes as well as a younger age at treatment onset with an increasing number of risk alleles in known risk genes (CFH and ARMS2/HTRA1) and polymorphisms in the VEGF-A gene. Clinical factors such as higher age, a better visual acuity (VA), a larger choroidal neovascularization (CNV) lesion at baseline, and a delay between symptom onset and initiation of treatment of more than 3weeks also impact outcomes. Conversely, a worse acuity at baseline predicted more gain in vision. Overall, patients presenting with good acuity at baseline were more likely to have good VA at follow up, but the gain afforded by treatment was impacted by a ceiling effect. Most available evidence suggests a strong association of clinical factors such as age, baseline VA, and CNV lesion size with anti-VEGF treatment outcomes. No behavioral factors such as smoking influence treatment outcomes. Based on the studies conducted so far, the evidence suggests that underlying genotype of known AMD risk associated genes or of the VEGF-A gene have a limited effect, whereas presenting clinical factors appear to be more important in determining treatment outcomes.

Original languageEnglish
Pages (from-to)1-18
Number of pages18
JournalSurvey of Ophthalmology
Volume59
Issue number1
DOIs
Publication statusPublished - Jan 2014
Externally publishedYes

Keywords

  • Age-related macular degeneration
  • Anti-VEGF
  • Bevacizumab
  • Ranibizumab
  • Risk gene
  • Treatment response

Cite this

Finger, Robert P. ; Wickremasinghe, Sanjeewa ; Baird, Paul N ; Guymer, Robyn H. / Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration. In: Survey of Ophthalmology. 2014 ; Vol. 59, No. 1. pp. 1-18.
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Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration. / Finger, Robert P.; Wickremasinghe, Sanjeewa; Baird, Paul N; Guymer, Robyn H.

In: Survey of Ophthalmology, Vol. 59, No. 1, 01.2014, p. 1-18.

Research output: Contribution to journalReview ArticleResearchpeer-review

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