The Impact of Switching Anti-Vascular Endothelial Growth Factor Therapy in the Management of Exudative Age-Related Macular Degeneration

Switching of anti-vascular endothelial growth factor (VEGF) therapy in the management of poorly responsive exudative age-related macular degeneration (AMD) has had suggested benefits in individual reports that have yet to be consolidated. In this retrospective review, 24 studies published between 2009 and 2014 were identified. Reasons for switching included tachyphylaxis, health insurance coverage, cost issues, and nonresponse or inadequate response. Nine studies had data that could be used for comparison between studies. Median follow-up was 10.6 months (range: 4.2 months to 21.8 months). Mean baseline visual acuity (VA) ranged from 0.42 logMar to 0.94 logMar (standard deviation [SD] range: 0.05 logMar to 0.50 logMar) and mean VA on final follow-up ranged from 0.38 logMar to 0.78 logMar (SD range: 0.08 logMar to 0.50 logMar). Five of nine studies reported no statistically significant change in vision, and five of nine studies reported a statistically significant improvement in central retinal thickness. This review found that switching anti-VEGF did not confer significant improvement of VA, although it provided some anatomical improvement. Pertinent considerations for evaluating response following anti-VEGF therapy are also presented in this review.