Incidence and Recovery of 15-Letter Loss of Visual Acuity in Patients With Neovascular Age-Related Macular Degeneration on Antivascular Endothelial Growth Factor Therapy

Purpose: To describe how 15-letter loss of visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD) results in transient fluctuations in vision. In addition, to compare recoverability of letter loss in patients treated with antivascular endothelial growth factor (anti-VEGF) with untreated patients. Methods: Patients with previously untreated nAMD in the Comparisons of AMD Treatments Trials were assigned to transient and nontransient groups based on recovery of baseline best-corrected VA within 8 weeks. Magnitude of recoverable letter loss was modeled via linear regression. Results: Two hundred fifty-three of 1018 patients (25%) experienced 15-letter loss: 68 transient (7%) and 185 nontransient (18%). Two-year outcomes were better without 15-letter loss (+12 letters, 95% CI, 11-13, n = 772) compared with transient 15-letter loss (+0.4 letters, 95% CI, −4 to 5) and nontransient 15-letter loss (−14 letters, 95% CI, −17 to −12). Nontransient losses up to −2.5 letters were expected to be recoverable (95% CI, −6.0 to 1.0). Fifteen-letter loss was associated with smoking ( P = .02) and poor nontransient outcomes with higher blood pressure ( P = .04). Conclusions: Patients experiencing transient and nontransient 15-letter loss differed significantly in outcomes. Nontransient losses were not expected to be recoverable. These findings may help guide the selection of measures in clinical trial design.