Baseline visual acuity as a prognostic factor for visual outcomes in patients treated with aflibercept for wet age-related macular degeneration: data from the INSIGHT study using the Swedish Macula Register

Purpose To assess mean change in visual acuity (VA) overall and stratified by baseline VA after 1 and 2 years' treatment with aflibercept in a real-life setting. Methods This was an observational cohort study using nationwide data from the Swedish Macula Register. Treatment-naive patient eyes with wet age-related macular degeneration and prescribed aflibercept from January 2013 to December 2014 were followed for 1 year (2478 eyes) or 2 years (831 eyes) to assess VA. Eyes were grouped by baseline VA. Results Mean number of injections in patients treated according to label (72%) versus patients treated not according to label was 8.0 +/- 1.5 versus 4.4 +/- 0.8 (p < 0.0001) at 1 year, and 12.5 +/- 3.2 versus 7.3 +/- 1.9 (p < 0.0001) at 2 years. Among all eyes, mean VA increased from 61.3 +/- 13.4 Early Treatment Diabetic Retinopathy Study letters at baseline to 64.5 +/- 15.6 at 1 year and 65.1 +/- 15.1 letters at 2 years. At 2 years, eyes with good baseline vision (>= 70 letters) lost a mean of 2.4 +/- 11.3 to 72.3 letters, eyes with intermediate baseline VA (36-69 letters) gained 5.7 +/- 14.1 to 62.7 letters, and eyes with poor baseline VA (<= 35 letters) gained 13.2 +/- 18.3 to 41.0 letters. Also at 2 years, 75% of treated eyes were stable or had improved VA. Among eyes with intermediate baseline VA, near vision was significantly better among those treated according to label versus not according to label at 3 (p = 0.019), 6 (p = 0.0002) and 12 months (p <= 0.0001). Conclusion While gain in vision was especially pronounced in eyes with poor baseline VA, good baseline VA was important for best prognosis.