Patient Mobility and Journey Distance as Risk Factors for Severe Visual Impairment: Real-Life Data Analysis of Treatment-naive Patients with nAMD under Intravitreal Aflibercept Therapy

Objective The aim of this study is to describe the effectiveness of aflibercept in treatment-naive patients with neovascular age related macular degeneration (nAMD) and the impact of patients' residential distance to the clinic and patients' mobility on therapy in a pro re nata regime. Methods A retrospective dataset analysis of 483 treatment-naive patients with nAMD was performed. The main outcomes were best corrected visual acuity (BCVA), central foveal thickness (CFT), bilateral visual impairment, distance and type of transport to the clinic. Secondary outcomes were injection rate, numbers and reasons of loss to follow-up. Results Patients received 4.91 +/- 1.9 injections in their first year and 7.06 +/- 3.6 after the period of 25 months (m). Initially the BCVA improved significantly after a loading dose from 0.72 logMAR (+/- 0.44) to 0.63 logMAR (+/- 0.45; p = 0.03). However, the BCVA significantly decreased after 2 years to 0.82 (+/- 0.48; p < 0.001). The proportion of patients with higher visual impairment and patients needing assistance with transport increased with the distance of their residence to the clinic (both p < 0.001). The LTFU rate was 3% and showed a correlation with greater age (p = 0.019). Conclusion The presented data show that aflibercept is effective for the treatment of nAMD. Although a good increase in visual acuity is initially achieved in the majority of patients, the initial success of treatment is not maintained throughout the course of the disease. Compared to controlled clinical studies, the presented data show reduced therapeutic success and lower injection frequencies. The rising demand for patient transport aid and increased visual impairment with increased distance indicate potential problems within the healthcare system.