Concern over treatment effect of anti-vascular endothelial growth factor (anti-VEGF) therapy on the health of the retinal-nerve fiber layer may be unwarranted, as long-term treatment does not appear to lead to significant changes in retinal-nerve fiber layer thickness.
In a study1 of 41 eyes of 37 consecutive patients who received various anti-VEGF agents for treatment of age-related macular degeneration, retinal-nerve fiber layer thickness changed from a mean 92.4 µm at time of presentation as measured on optical coherence tomography (OCT) to a mean 93.8 µm at time to last follow-up.
Patients were followed for an average of 27 months and received an average of 16 intravitreal injections. Intraocular pressure (IOP) levels were not reported in the study; however, previous studies have indicated that use of anti-VEGF agents may lead to elevation of IOP in the period after injection, which could theoretically damage the retinal nerve fiber layer.
Nevertheless, change in retinal nerve fiber layer thickness is an established correlate of glaucomatous progression. But in the current study, change in thickness was far below what would be expected to demonstrate clinical significance.
"There is no apparent effect on [retinal nerve fiber layer] thickness with chronic intravitreal anti-VEGF use," the study authors wrote.
1. Am J Ophthalmol. 2010; doi:10.1016/j.ajo.2010.04.029.