Data from the Fight Retinal Blindness! (FRB!) registry has revealed prolonged gaps in treatment for neovascular age-related macular degeneration (nAMD) are common – and are associated with significant, often persistent, declines in vision.
The retrospective multicentre study used data from the FRB! Registry to evaluate visual outcomes and visit gap occurrences in patients receiving anti-VEGF therapy. The study was published in Opthalmology Retina.1
The researchers analysed data on 262 treatment-naïve nAMD eyes that began intravitreal anti-VEGF, were regularly monitored in the first year, and then experienced a gap of six to 12 months, with at least three follow-up visits over the subsequent nine months.
Study authors said while the treatment of nAMD had been “revolutionised” by the introduction of vascular endothelial growth factor (VEGF) inhibitors, a significant number of patients still require repeated intravitreal injections and close monitoring to maintain vision.
Treated eyes experiencing a six to 12-month visit gap had a significant drop in vision immediately after the gap
“Patient adherence to intravitreal VEGF therapy regimens remains a significant challenge and explains why real-world outcomes remain poorer than those seen in randomised clinical trials due to undertreatment,” study authors wrote.
They found that visit gaps were “common” and lead to significant, often irreversible, functional decline, particularly in eyes with active choroidal neovascularisation and no subfoveal macular atrophy.
The registry did not capture reasons for visit gaps, which may include planned treatment extensions, patient nonadherence, illness, or logistical factors.
Treated eyes experiencing a six to 12-month visit gap had a significant drop in vision immediately after the gap. with a mean estimated change in visual acuity (VA) of -4.9 letters. Further analysis showed an approximate one-line decline in VA at the time of the gap, after which vision remained relatively stable over the following months, with no significant recovery observed at the group level..
“This suggests that the effect of treatment interruption on vision is concentrated at the time of the gap rather than evolving progressively thereafter,” the authors concluded.
Eyes with active CNV at the visit preceding the gap experienced a greater mean VA loss than those with inactive lesions. While vision remained stable in eyes with inactive CNV after the gap, eyes with active CNV showed some improvement once treatment resumed, indicating a degree of potential recovery despite larger initial losses.
“This suggests that disease activity dynamics across the interruption are important in interpreting functional outcomes after prolonged lapses in follow up,” researchers wrote. “This finding is not surprising and confirms the detrimental visual effects of ongoing fluid when care is interrupted in nAMD.”
The authors found visit gaps were relatively common in routine practice; approximately a quarter of eyes experienced a six to 12-month gap within 6.5 years, the researchers noted. Longer injection intervals and longer times since the last injection were associated with an increased likelihood of visit gaps. In contrast, better visual acuity during follow-up, receiving an injection at each visit, and the presence of subretinal fluid only were associated with a lower likelihood of a visit gap.
Reference
Goncalves L, Hashimoto Y, Gillies M, Gabrielle PH, et al; Real-world outcomes in neovascular AMD with visit gaps under anti-VEGF therapy: Data from the FRB! Registry. Ophthalmology Retina , 2026 April; article in press. Available at: ophthalmologyretina.org/article/S2468-6530(26)00150-8/fulltext [access April 2026].
