OBJECTIVES : - In randomized controlled trials (RCTs), anti-VEGF therapy significantly improved patients’ visual acuity (VA) and vision related quality of life. Our objective was to assess if the efficacy observed in the RCTs also translated into reducing blindness and visual impairment in clinical practice.

METHODS : - A systematic literature review (SLR) was completed using Medline® and EMBASE for publications (prior to 20/07/2018) and proceedings from major ophthalmology conferences (01/2016 to 07/2018). The search strategy used search terms for nAMD combined with search terms for anti-VEGF therapy and study design. The review focused on publications describing the impact of anti-VEGF on blindness and visual impairment outcomes. The search targeted data collected in epidemiological (population based) or observational studies to reflect real world outcomes.

RESULTS : - The SLR identified 8 publications addressing the impact of anti-VEGF on vision related outcomes (7 manuscripts and 1 abstract). Four publications described registry-based studies and four cohort-based studies. The visual related outcomes were assessed considering the impact on blindness (8 studies), visual impairment (2 studies) and ability to drive (1 study). Researchers described a reduction of up to 50% in the incidence of legal blindness due to nAMD since anti-VEGF agents were introduced in clinical practice. The odds of decreased vision (defined as decline from normal to moderate, moderate to severe, or severe to blindness) fell by 41%, while moderate and mild impairment (defined as 20/80 and 20/40 in better-seeing eye) was reduced by 78% and 70%, respectively. One study reported that the proportion of nAMD patients suitable for driving (VA in the better eye ≥70 ETDRS letters) increased from 27% to 51.4% (p<0.0001).

CONCLUSIONS : - The published evidence confirms that the introduction of anti-VEGF treatment in nAMD has had a direct positive effect in reducing the incidence of blindness and visual impairment in clinical practice.