Summary: long-term morbidity

In the CATT trial, 480 of 1,059 eyes (45.3%) receiving anti-VEGF therapy developed scar by 2 years (fibrotic scar 24.7%, nonfibrotic scar 20.6%). A 2026 review reports that 20% to 67% of treated participants develop macular fibrosis within 2 to 7 years. In a US TriNetX cohort of 92,849 people with neovascular AMD, 21.24% had a diagnosis of visual impairment, the highest proportion among the single ocular diseases analyzed. Globally, 1.85 million people were blind and 6.23 million had moderate or severe vision impairment due to AMD in 2020. In a French nationwide cohort of 1,662 people with incident treated neovascular AMD, the condition was associated with a 19% increase in the risk of disability in activities of daily living and of mood disorders.

Scar formation during anti-VEGF therapy: CATT

“Scar developed in 480 of 1059 eyes (45.3%) by 2 years.” (opens the source at this quote in a new tab)
“Fibrotic scars developed in 24.7% of eyes, and nonfibrotic scars developed in 20.6% of eyes.” (opens the source at this quote in a new tab)

Macular fibrosis as an end-stage complication

“Macular subretinal fibrosis represents the end-stage complication of neovascular age-related macular degeneration (nAMD). Despite the widespread use of anti-VEGF therapy, between 20 and 67% of nAMD patients develop this sight-threatening condition within 2 to 7 years, making fibrosis one of the main reasons responsible for anti-VEGF resistance and irreversible visual loss.” (opens the source at this quote in a new tab)

Visual impairment among people with neovascular AMD in the United States

“The prevalence of having a visual impairment which is composed of the sum of patients with low vision and blindness was highest among neovascular AMD patients at 21.24% and lowest among DR patients at 12.63% (Table 1).” (opens the source at this quote in a new tab)

AMD as a cause of blindness in the United States

“The leading cause of blindness among white persons was age-related macular degeneration (54.4% of the cases), while among black persons, cataract and glaucoma accounted for more than 60% of blindness.” (opens the source at this quote in a new tab)

Global blindness and moderate or severe vision impairment due to AMD, 2020

“In 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77).” (opens the source at this quote in a new tab)

Disability and mood disorders after treated neovascular AMD: French nationwide cohort

“During the study period, 1662 cases of incident nAMD were identified. After adjustment for age, sex, Charlson comorbidity index and number of drugs, nAMD was significantly associated with the occurrence of ADL disability (Hazard ratio (HR): 1.19, 95% confidence interval (CI): 1.08–1.30; p = 0.0002) and of mood disorders (HR: 1.19, 95%CI: 1.07–1.32; p = 0.002). Associations with falls, fractures and head trauma were not statistically significant.” (opens the source at this quote in a new tab)

Irreversible vision loss after interrupted anti-VEGF therapy

“When treatments are interrupted, discontinued, or both, irreversible vision loss can occur.” (opens the source at this quote in a new tab)
“Outside of clinical trials, in clinical practice, patients with neovascular AMD who became LTFU during anti-VEGF therapy experienced significant visual decline at the return visit that persisted despite the normalization of retinal anatomic features with the resumption of care.” (opens the source at this quote in a new tab)
“Interruptions to anti-VEGF treatment led to irreversible vision loss that could not be recovered with the resumption of care.” (opens the source at this quote in a new tab)

Duravyu (vorolanib intravitreal insert)

Long-term morbidity