Factors associated with achieving various visual acuity outcomes during loading doses of aflibercept 2mg for treatment naïve exudative age-related macular degeneration: PRECISE Study Report 7

PURPOSE: To examine baseline OCT characteristics of patients initiated on aflibercept 2mg that achieved good and suboptimal VA after the first injection and post-loading. METHODS: Patients with nAMD initiated on aflibercept therapy were recruited from December 2019 to August 2021. Demographic and OCT (Spectralis, Heidelberg Engineering) features associated with good VA (VA>=68 ETDRS letter score, Snellen >= 6/12) and poor VA (VA < 54 letter score, Snellen < 6/18) or lost >= 5 ETDRS letters after first injection (V2) and after the loading phase (V4) were analysed using logistic regression via generalised estimating equations. RESULTS: A total of 1,999 eyes of 1,862 patients were analysed. The mean age was 79.3 (SD 7.8) years, 1,126 (60.5%) were female, predominantly white ethnic background (1,772 [95.2%]) and the mean presenting VA was 58.0 (SD 14.5) ETDRS letter score. After V4, 930 (46.6%) of 1,994 eyes achieved VA>=68 ETDRS letter score and 457 (22.9%) achieved VA<54 ETDRS letter score. The OCT parameters found to be associated with reduced odds of VA >=68 ETDRS letter score and increased odds of VA < 54 ETDRS letter score included foveal-involving IRF, PCV (vs. Type 1), RAP (vs. Type 1), Type 2 eyes (vs. Type 1), foveal-involving CNV (vs. non-foveal CNV), any component of CNV complex, increased CST, foveal-involving SRHM, foveal-involving atrophy, foveal-involving fibrosis, foveal-involving EZ loss, foveal-involving ELM loss, ungradable EZ loss, ungradable ELM loss and foveal-involving EZ/ELM loss. CONCLUSION: This study could help inform patients about their post-loading VA based on OCT characteristics at presentation.