title: Rate of vision loss in neovascular age-related macular degeneration explored.
abstract: OBJECTIVE
  To explore decline in visual acuity in patients with neovascular age-related macular degeneration (n-AMD) awaiting intravitreal bevacizumab or ranibizumab treatment following initial diagnosis and after disease reactivation.
  
  
  METHODS
  Retrospective analysis of 74 treatment-naïve patients (84 eyes) in two centers in Córdoba, Argentina. The time between treatment indication and intravitreal injection, and the changes in BCVA produced during this delay were studied in both periods. A linear regression model to search the impact of time on progression visual impairment was conducted.
  
  
  RESULTS
  In both periods, a significant reduction in vision occurred awaiting intravitreal injection. The longer the delay, the greater the vision loss (R2 = 0.55 p < 0.01) and the less improvement following treatment (Pearson coefficient -0.26). The result of the model shows that the change in vision as a function of initial delay were best described by a polynomic model with a mean loss of 5 letters in the first 3 weeks, a slowdown in the rate of change of VA, and a dependence of visual acuity at the moment of diagnosis . The loss of visual acuity after reactivation shows the same behavior as at the onset of the disease but independent of visual acuity prior to reactivation.
  
  
  CONCLUSIONS
  Visual loss awaiting injection intravitreal anti-VEGF is clinically significant and with an asymptotic pattern, with early rapid loss of vision in both the onset of the disease and the reactivation. Initiation of anti-VEGF treatment must be undertaken urgently, as should retreatment of disease activation to reduce visual loss.
authors.affiliation: Pharmacy Department of the Faculty of Chemical Sciences, National University of Córdoba UNITEFA (CONICET), Cordoba, Argentina.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Real
authors.affiliation: Pharmacy Department of the Faculty of Chemical Sciences, National University of Córdoba UNITEFA (CONICET), Cordoba, Argentina.
authors.forename: Gladys E
authors.initials: GE
authors.lastname: Granero
authors.affiliation: Institute of Economics and Finance, School of Economics Sciences, National University of Córdoba, Córdoba, Argentina.
authors.forename: Mariana O
authors.initials: MO
authors.lastname: De Santis
authors.affiliation: Vitreo-Retinal Department, Centro Privado de Ojos Romagosa SA - Fundación VER, Córdoba, Argentina Dean Funes, 432, 5000, Córdoba, Argentina.
authors.forename: Claudio P
authors.initials: CP
authors.lastname: Juarez
authors.affiliation: Pharmacy Department of the Faculty of Chemical Sciences, National University of Córdoba UNITEFA (CONICET), Cordoba, Argentina.
authors.forename: Santiago D
authors.initials: SD
authors.lastname: Palma
authors.affiliation: Ophthalmology Department, Royal Bolton Hospital, Bolton, UK.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kelly
authors.affiliation: Vitreo-Retinal Department, Centro Privado de Ojos Romagosa SA - Fundación VER, Córdoba, Argentina Dean Funes, 432, 5000, Córdoba, Argentina. moonpintojd@outlook.com.
authors.forename: José D
authors.initials: JD
authors.lastname: Luna
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000627:therapeutic use; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*; D057832:Watchful Waiting; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab
keywords: Age-related macular degeneration; Bevacizumab; Disease progression; Health systems; Patient safety; Ranibizumab