OBJECTIVES: Describe the frequency of bilateral anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients with one and four years of follow-up and the proportion of better-seeing or worse-seeing eyes treated at baseline.

METHODS: Data were extracted from a panel of 55 retina practices across the USA using a standardized electronic medical record system. Patients considered treatment-naïve (no anti-VEGF treatment for >180 days before first treatment), aged ≥50 years, and diagnosed with nAMD between January 2012 and June 2016 were included. Better-seeing or worse-seeing eyes were classified per the definitions used by the Age-Related Eye Disease Study Group.

RESULTS: 145574 patients were included, whereof 79885 were eligible for analysis. 12340, 18929, 29056, and 19560 initiated treatment in 2012, 2013, 2014 and 2015, respectively. The frequency of bilateral treatment at baseline was 26.7% in 2012, 25.7% in 2013, 24.1% in 2014 and 19.8% in 2015. In patients with one year of follow-up (N=41321), treated unilaterally at baseline, the frequency of bilateral treatment was 25.1% (1803/7187), 24.4% (2397/9831), 23.2% (3654/15742) and 16.9% (1444/8561) for 2012, 2013, 2014 and 2015, respectively. In patients with four years of follow-up, treated unilaterally at baseline (n=2456), the frequency of bilateral treatment in the first, second, third and fourth year was 27.6%, 30.4%, 32.2% and 32.8%, respectively. Of eyes treated unilaterally at baseline with a record of visual acuity at first treatment (n=10978), 32.0% (n=3514) were better-seeing eyes and 60.0% (n=6592) worse-seeing eyes. Proportions of treated better-seeing eyes and worse-seeing eyes were consistent across years.

CONCLUSIONS: In US clinical practice, the majority of first treated eyes are worse-seeing eyes. The frequency of bilateral treatment increased gradually following the first treatment year in patients with four years of follow-up.