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dc.contributor.authorNguyen, Chu Luan
dc.date.accessioned2019-10-03
dc.date.available2019-10-03
dc.date.issued2019-02-27
dc.identifier.urihttp://hdl.handle.net/2123/21177
dc.description.abstractPurpose:To investigate the incidence, characteristics and baseline predictors of poor visual outcomes in eyes with neovascular age-related macular degeneration (nAMD) receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in daily clinical practice. Design:Observational study. Participants:Treatment-naïve eyesstarting anti-VEGF therapy for nAMD between 2007 and 2012 tracked in the Fight Retinal Blindness! registry.Cases had sustained ≥15 letters of loss from baseline without recovery of visual acuity (VA) at final endpoint.A subgroup analysis included eyes thatsustained ≥30 letters of loss. Controls had not sustained ≥15 letters of loss. Methods:Kaplan-Meier curves estimated time to first development of loss of ≥15 letters. Cox-proportional hazards models evaluated predictors of loss of ≥15 letters. Main Outcome Measures: The proportion of eyes with sustained VA loss within5 years, the time to development of sustained VA loss and baseline predictors of sustained VA loss. Results:There were 1760 eyes in total and 856 eyes that completed 5 years follow-up. The proportion of eyes with sustained VA loss of ≥15 letters at 5 years was 22.9% (95%CI, 20.7-25.1) andVA loss of ≥30 letters was 10.8% (95%CI, 9.1-12.5). Factors independently associated with higher incidence of sustained ≥15 letter loss included age >80 years (odds ratio [OR], 1.33 for patients >80 years vs. ≤80 years; 95%CI, 1.05-1.69; P =.02), fewer injections(OR, 0.97 per injection; 95%CI, 0.96-0.98; P=.0005) and more visits at which the choroidal neovascularisation was graded as active (OR, 1.97 for eyes in upper quartile of active visits vs. eyes in lowest quartile of active visits; 95%CI, 1.39-2.79; P=.0001). Baseline VA≥70 letters was associated with reduced risk of sustained ≥30 letter loss (OR, 0.61; 95%CI, 0.38-0.98; P=.04). Baseline angiographic lesion criteria were not significantly associated with sustained VA loss. Conclusions:Twenty-three percent of eyes with nAMD developed sustained VA loss of ≥15 letters over 5 years of anti-VEGF therapy. Baseline predictors of poor outcomes provide more accurate assessment of the potential benefit from anti-VEGF therapy.en_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectMacular degenerationen_AU
dc.subjectanti-VEGFen_AU
dc.titleCharacterisation of poor outcomes of neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agentsen_AU
dc.typeThesisen_AU
dc.type.thesisMasters by Researchen_AU
usyd.facultyFaculty of Medicine and Healthen_AU
usyd.departmentThe Save Sight Instituteen_AU
usyd.degreeMaster of Philosophy in International Public Health M.Phil.Int.P.H.en_AU
usyd.awardinginstThe University of Sydneyen_AU


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