Progression of visual loss and time between initial assessment and treatment of wet age-related macular degeneration

Purpose: To determine whether the time elapsed from initial (referral) diagnosis of neovascular (wet) age-related macular degeneration (AMD) to assessment and treatment by a retinal specialist is associated with visual deterioration in the intervening period. Methods: A prospective pilot study of 38 consecutive AMD patients who presented with newly diagnosed subfoveal choroidal neovascularization was conducted in a tertiary care retinal practice. All eligible subjects underwent clinical examination and digital fluorescein angiography at the time of assessment by a retinal specialist. Correlations were performed to assess the association between continuous independent variables and any visual deterioration since initial diagnosis. Multivariate linear regression models with stepwise techniques were used to evaluate any association between visual progression and time elapsed, while controlling for potential clinical covariates. Results: Of the 38 patients, 32 (84%) met the inclusion and exclusion criteria; no differences in important variables were noted between those included and those excluded. The median time between initial diagnosis and referral assessment and treatment was 28 days (interquartile range = 36.5 days); some degree of visual loss developed in 14 (44%) of the subjects. The elapsed time was correlated with progression of visual loss (r = 0.50, P = 0.003). Multivariate linear regression demonstrated that only time elapsed and lesion type based on fluorescein angiography were associated with progression of visual loss (R-2 = 0.49 1, F(4,28) = 6.744, P = 0.00 1); lesion size, age and sex were not significantly associated with progression of visual loss. Interpretation: Delay in assessment and treatment of new-onset wet AMD by a retinal specialist is associated with a higher risk of visual loss.