Clinical Ophthalmology (Jan 2020)
Treatment Course of Patients with Exudative Age-Related Macular Degeneration Using Ocular Hypotensives
Abstract
Bobeck S Modjtahedi, 1–3 Tiffany Q Luong, 3 Stephan Chiu, 2 Tavé van Zyl, 4 Jane C Lin, 3 Donald S Fong 1–3 1Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA; 2Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA; 3Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA; 4Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, MA, USACorrespondence: Bobeck S ModjtahediEye Monitoring Center, Kaiser Permanente Southern California, 1011 Baldwin Park Blvd, Baldwin Park, CA 91706, USAEmail [email protected]: To characterize the visual outcomes and the treatment course of patients with exudative age-related macular degeneration (AMD) based on ocular hypotensive use.Design: A matched retrospective cohort study of patients enrolled in Kaiser Permanente Southern California health plan was conducted. Patients taking ocular hypotensives were identified using pharmacy dispensing data and were matched to controls to compare visual acuity, number of anti-VEGF injections, and conversation to secondary anti-VEGF agents in the first year of treatment. Subgroup analysis was performed based on the number of ocular hypotensive agents (0, 1, 2 or 3+ agents) and drug class (aqueous suppressants and prostaglandin analogs).Results: A total of 234 patients patients were examined. Baseline and final visual acuity did not significantly differ between drop users and controls, including on subgroup analysis. The average number of anti-VEGF injections did not differ between drop users and controls (6.1 vs 6.2, p=0.97), nor did the percentage of patients who were switched to a second-line anti-VEGF agent (23.9% vs 17.9%, p=0.26). Subgroup analysis did not reveal significant differences in the number of anti-VEGF injections and the percentage of patients switched to secondary agents, with patients receiving 6 ± 1 injections across regardless of the number or class of ocular hypotensive agents used.Conclusion: Patients with concurrent glaucoma and exudative AMD have similar visual outcomes and treatment courses compared to those not taking ocular hypotensives. Although aqueous suppressants have been suggested to prolong anti-VEGF residence time, patients using these agents did not demonstrate visual benefit or a reduced injection burden in this series.Keywords: age-related macular degeneration, bevacizumab, glaucoma, aqueous suppressant, pharmacology, pharmacokinetics, vascular endothelial growth factor, intravitreal injection
