Preserving Visual Acuity: A Compelling 12-Year Case Study of Controlling Neovascular Age-Related Macular Degeneration

Abstract

Abstract Background: In neovascular age-related macular degeneration (nAMD) trials, anti-VEGF injection frequency declines after the first year, while outcomes remain primarily related to the number of injections. To date, there are no documented real-life cases in the literature reporting long-term preservation of best corrected visual acuity (BCVA) for more than 7 years in nAMD. We present a 12-year follow-up of a real-life case of nAMD where BCVA was preserved. Case presentation: A 67-year-old Caucasian female presented to our department in June 2010 due to decreased vision in her left eye (LE) within the preceding months. Examination showed a BCVA of 85 letters (L) in the right eye (RE) and 35 L in the LE. Fundus examination showed drusen in the macula of both eyes and macular edema in the LE. A diagnosis of Type 1 choroidal neovascular membrane (CNV) in the RE and Type 2 CNV in the LE was established. She undergone 7 injections within the first year in either eye. The LE had a mean of five injections per year, and the RE had a mean of seven injections per year, from 2010 to 2022. RE's BCVA dropped by 8 L (85 L to 77 L) and central retinal thickness (CRT) increased by 16 μm (276 μm to 292 μm), while LE’s BCVA increased by 28 L (35 L to 63 L) and CRT decreased by 369 μm (680 μm to 311 μm), at the twelfth year. Conclusions: The number of injections is paramount in preserving BCVA and achieving favorable functional outcomes in nAMD, even after 12 years of treatment.