Incidence and Risk Factors of Visual Impairment in Patients with Angioid Streaks and Macular Neovascularization

Objective: To estimate the incidence and risk factors of visual impairment and complications in eyes with macular neovascularization (MNV) because of angioid streaks (ASs). Design: Longitudinal multicenter retrospective cohort study. Subjects: Patients with AS-associated MNV treated with anti-VEGF agents and a follow-up of > 3 months. Methods: Clinical and MNV characteristics were collected at baseline. Visual acuity (VA) values and the presence of atrophy or fibrosis were collected at each visit. Main Outcome Measures: Rate of VA change over time and associated factors; the incidence rate of moderate-to-severe visual impairment (MSVI) and blindness and hazard ratio (HR) of candidate risk factors for MSVI; the incidence rate of fibrosis and macular atrophy. Results: Overall, 84 eyes of 66 patients (39 men, 58%) with a mean (standard deviation) age of 55.7 (13.8) years were followed for a mean (standard deviation) of 67.7 (48.5) months. The median number of anti-VEGF doses per eye was 13. The average rate (95% confidence interval [CI]) of visual loss was +0.04 (0.02–0.06) logarithm of the minimum angle of resolution/year (P < 0.001); the visual loss was faster in nonnaive eyes (P = 0.007) and those with better baseline VA (P < 0.001); it was slower in eyes with pattern dystrophy–like features (P = 0.04). The incidence rates (95% CI) of MSVI and blindness were 10.4 (6.88–15)/100-eye-years and 2.33 (1.12–4.29)/100-eye-years. A higher number of injections (HR [95% CI] = 0.45 [0.19–0.94] for receiving ≥ 13 injections vs. < 13; P = 0.03) was protective against MSVI. The incidence rates (95% CI) of fibrosis and macular atrophy were 24.1 (17.5–32.3)/100-eye-years and 14.3 (10.1–19.6)/100-eye-years. Conclusions: Eyes with MNV-related AS had a high rate of visual impairment and propensity to macular fibrosis and atrophy. A higher number of injections yielded better chances of maintaining good VA, suggesting the need for intensive treatment. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.