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Comment on: “Lesion area progression in eyes with neovascular age-related macular degeneration treated using a proactive or a reactive regimen”

Eye (2024)Cite this article

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We commend the study conducted by Cozzi et al. [1] for its insightful contributions to the ongoing management of patients with neovascular age-related macular degeneration (nAMD) undergoing an anti-VEGF intravitreal regimen. This retrospective cohort study, carried out in centers across Italy and Australia, meticulously examined the progression of neovascular lesion areas, identifying differences between two antiangiogenic treatment strategies: proactive and reactive. Notably, the imaging results, which correlate lesion area with clinical outcomes, bolster the evidence that proactive regimen yields superior visual outcomes [2]. Furthermore, the calculation of lesion area utilized a pioneering method that leverages the relationship between near-infrared reflectance and optical coherence tomography.

Nevertheless, we would like to discuss the differences in the analyzed population. Primarily, the statistical analysis should account for patient characteristics at each healthcare center, given the application of the treatments to demographically varied populations. While the study’s adoption of a longitudinal mixed-effects model to evaluate the influence of predictive variables such as age or nAMD type on outcomes is notable, a cluster analysis by center might provide more definitive statistical insights for patients from different populations accounting for variables that are not easily accessible for adjustment [3]. Secondly, the study could further benefit from considering additional nAMD-related risk factors, such as cardiovascular diseases, which share pathophysiological mechanisms with nAMD, including hypertension, obesity, and smoking [4], as well as dietary habits (protective, e.g., Mediterranean, vs. risky, e.g., Western) [5] or ethnic backgrounds [4]. The geographical variation in the prevalence of these risk factors suggests that their inclusion in the analysis might provide a deeper understanding of outcomes.

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References

  1. Cozzi M, Monteduro D, Esposito RA, Spooner K, Fraser-Bell S, Staurenghi G, et al. Lesion area progression in eyes with neovascular age-related macular degeneration treated using a proactive or a reactive regimen. Eye. 2024;38:161–7.

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  4. Mauschitz MM, Finger RP. Age-related macular degeneration and cardiovascular diseases: revisiting the common soil theory. Asia Pac J Ophthalmol. 2022;11:94–9.

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Authors and Affiliations

  1. Grupo de investigación en Visión y Salud Ocular (VISOC), Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia

    Andrés Felipe Niño-Joya, Alexander M. Martínez-Blanco, Omar Salamanca & Francisco J. Bonilla-Escobar

  2. Oftalmosanitas Cali S.A.S., Cali, Colombia

    Andrés Felipe Niño-Joya & Alexander M. Martínez-Blanco

  3. Orbis International, New York, NY, USA

    Omar Salamanca

  4. Department of Ophthalmology, University of Washington, Seattle, WA, USA

    Francisco J. Bonilla-Escobar

  5. Fundación Somos Ciencia al Servicio de la Comunidad, Fundación SCISCO/Science to Serve the Community Foundation, SCISCO Foundation, Cali, Colombia

    Francisco J. Bonilla-Escobar

Authors
  1. Andrés Felipe Niño-Joya
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  2. Alexander M. Martínez-Blanco
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  3. Omar Salamanca
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  4. Francisco J. Bonilla-Escobar
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Concept, writing, editing, and approval of the final version of the manuscript: AFNJ, AMMB, OS, FJBE.

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Correspondence to Andrés Felipe Niño-Joya.

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Niño-Joya, A.F., Martínez-Blanco, A.M., Salamanca, O. et al. Comment on: “Lesion area progression in eyes with neovascular age-related macular degeneration treated using a proactive or a reactive regimen”. Eye (2024). https://doi.org/10.1038/s41433-024-03063-8

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  • DOI: https://doi.org/10.1038/s41433-024-03063-8

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