Intravitreal anti-VEGF treatment for neovascular AMD tied to glaucoma progression

Age-related macular degeneration and glaucoma cause permanent visual impairment in developed countries, including Finland. Intravitreal injections with anti-vascular endothelial growth factors (anti-VEGF) are the primary therapeutic approach for nAMD.

The literature mentions mixed results on glaucoma progression during anti-VEGF treatment for nAMD. It may also lead to an increased risk for glaucoma surgery.

Dr Inka Pirinen and colleagues investigated,

How often do glaucoma and nAMD occur in the same patient, and whether glaucoma progression is faster on treatment with intravitreal anti-VEGF used for managing nAMD?

Tays Eye Center's patient medical records of 6314 glaucomas and 2166 nAMD patients were available. The researchers compared changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) with and without anti-VEGF treatment for nAMD and ≥ 1-year follow-up.

The study results are:

• During ten years, one hundred forty-seven glaucoma patients received intravitreal anti-VEGF treatment for nAMD ( 2% of glaucoma and 7% of nAMD patients).

• The mean change in MD was −0.70 dB/year (SD 1.8) vs −0.27 dB/year (SD 1.7) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively.

• In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at −0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5).

• The progression of glaucoma was detected in 14 of 20 vs 10 of 20 fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes.

To conclude, intravitreal anti-VEGF treatment for nAMD may accelerate the progression of glaucoma. The team mentioned that nAMD requiring anti-VEGF treatment occurred in combination with glaucoma at the same rate as in the general population.

Further reading:

Pirinen, I., Leinonen, S., Helminen, M., Hujanen, P., Vaajanen, A., Tuulonen, A., & Uusitalo‐Järvinen, H. (2022). Glaucoma progression in patients receiving intravitreal anti‐VEGF treatment for neovascular age‐related macular degeneration. Acta Ophthalmologica. https://doi.org/10.1111/aos.15288