Study Finds One in Five Wet AMD Cases Did Not Receive Anti-VEGF Within First Year

Lower anti-VEGF treatment initiation rates are associated with Black and Asian race, Hispanic ethnicity, age younger than 60 years, residence in the South compared to the West region and low-vision status. These disparities in treatment initiation emerged early and persisted throughout the first year of follow-up. Photo: Leonid Skorin Jr., DO, OD, MS. Click image to enlarge.  Timely diagnosis and intervention in the effective management of neovascular AMD (nAMD) is critical to help prevent vision loss. Access to these treatments, including anti-VEGF, is influenced by the availability of eye care and various sociodemographic factors, with previous research highlighting significant barriers. In a recent study using data from the American Academy of Ophthalmology IRIS Registry, researchers investigated disparities in the presentation and initiation of anti-VEGF therapy for nAMD and found that over 20% of patients did not initiate treatment within the first year of presentation. The findings were reported in Ophthalmology.Disparities in receiving anti-VEGF therapy were observed on the day of the first presentation with nAMD and within 30 days, and persisted throughout the year. Among 918,759 patients with nAMD (61.5% female, 82.3% white), male, Black and Hispanic patients presented with nAMD at younger ages. Only 78.3% patients initiated anti-VEGF treatment within a year, with 71.1% receiving the first injection within a month. Relatively small differences among racial and ethnic cohorts were also found: Black and Asian patients were somewhat less likely to initiate treatment compared to white patients (9% and 5%, respectively) while Hispanics were 4% less likely to initiate treatment than non-Hispanic patients.One proposed explanation for the age disparity in treatment is that younger patients may be less compliant with recommended injection regimens, possibly consistent with studies linking younger age to non-adherence with diabetic retinopathy and glaucoma screening, the authors suggested. “Other studies have also suggested that older age may predict loss to follow-up and non-persistence in nAMD treatment, potentially due to a higher prevalence of comorbidities and transportation challenges,” they wrote in their Ophthalmology paper.Geographic disparities were also observed, with patients in the Western US more likely to initiate treatment than those in the South, Midwest and Northeast. Other studies have highlighted barriers in certain regions as well. “For instance, an IRIS Registry-based study found that patients with nAMD in the South had higher rates of being lost to follow-up—defined as no follow-up within 12 months of the last intravitreal injection—than those in the West, Midwest or Northeast,” the authors wrote in their paper.Supporting these findings, another study reported that census tracts with the greatest travel burdens to wet AMD clinical trial sites were predominantly rural and located in the Midwest and Southern US. Additionally, it’s also been reported that 83.1% of counties with the highest rates of both severe vision loss and poverty were in Southern states, “underscoring how socioeconomic and geographic factors may impact access and adherence to treatment.”Only about half of the patients with wet AMD presenting with hand motion or worse vision received anti-VEGF injections within the first year after presentation. In contrast, patients with a presenting VA between 20/40 and 20/200 had the highest treatment initiation rate of 84.5%.The authors noted that the retrospective nature of this study limits their ability to fully understand the reasons behind undertreatment in both patients with relatively good and poor baseline VA. “Patients with normal vision may not recognize the long-term impact of the disease due to their asymptomatic presentation, potentially affecting their motivation to seek treatment,” the authors wrote in their paper. “Moreover, patients with normal vision may have been coded as having nAMD at presentation, but some of these cases may have reflected uncertain or suspected nAMD that was not confirmed in the ensuing months.”On the other hand, they said, clinicians may approach advanced AMD cases less aggressively, possibly due to perceived limitations in the potential for therapeutic improvement or meaningful gains in quality of life.“While we defined ‘treated’ as receiving at least one injection within the first year, effective management of nAMD requires repeated, timely injections, and this metric reflects only the initiation of therapy,” the authors concluded in their paper. “Future studies are needed to investigate the reasons behind undertreatment and identify strategies to improve both treatment initiation and continuity. Addressing barriers to care is critical to ensure equitable access and prevent irreversible vision loss in patients with nAMD.”Click here for the journal source. Acharya B, Momenaei B, Zhang Q, et al. Disparities in presentation and anti-VEGF therapy initiation for neovascular AMD: An analysis of the Academy IRIS Registry. Ophthalmology. July 21, 2025. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.