To evaluate whether early visual acuity response at 4 weeks after the first intravitreal anti-vascular endothelial growth factor (VEGF) injection or 4 weeks after the third injection in neovascular age-related macular degeneration (nAMD) is associated with 12-month follow-up outcome.

Thirty treatment-naive patients (30 eyes) with nAMD, treated with intravitreal anti-VEGF, were retrospectively included. Initially, all patients were injected at least three times for three consecutive months and followed up with a pro re nata regimen for at least 12 months. The relationship between 4 weeks after the first and third anti-VEGF injections in visual acuity response was explored, including the mean change from baseline in best-corrected visual acuity (BCVA). The mean change in BCVA was classified into three groups according to visual improvement: <1, 1-<3, or ≥ 3 logMAR line(s) in BCVA. The associations among baseline characteristics (gender, age, duration of symptoms, initial BCVA, central macular thickness, and intraocular pressure) and visual acuity responses 4 weeks after the first and third anti-VEGF injections were also assessed.

The proportions of eyes with <1, 1-<3, and ≥ 3-line(s) improvement at 4 weeks after the first injection were 6 eyes (20%), 7 eyes (23.3%), and 17 eyes (56.6%), respectively. The proportions of eyes with <1, 1-<3, and ≥ 3-line(s) improvement at 4 weeks after the third injection were 9 eyes (30%), 9 eyes (30%), and 12 eyes (40%), respectively. A BCVA response ≥ 3-lines improvement at 4 weeks after the third injection showed significant associations with ≥ 3-lines improvement and BCVA response at 12 months in multiple logistic and linear regression analyses ( p = 0.04).

In this study, BCVA response ≥ 3-lines improvement at 4 weeks after the third injection showed a significant association with ≥ 3-lines improvement and BCVA response at 12 months.