A 5-year multicenter prospective cohort study on the long-term visual prognosis and predictive factors for visual outcome in Japanese patients with age-related macular degeneration: the AMD2000 study
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In this study (AMD2000), we aimed to determine the visual prognosis of Japanese patients with age-related macular degeneration (AMD).
This was a multicenter prospective observational cohort study. In total, 460 patients with AMD were recruited from April 2006 to March 2009 from 18 clinical trial sites in Japan. They were followed up for 5 years, as they continued to receive medical treatment.
Of the 409 study eyes followed up for at least 1 year, 243 eyes (59.4%) were treated with photodynamic therapy (PDT) using verteporfin, and 58 eyes (14.2%) were treated with intravitreal injections of antivascular endothelial growth factor agents as the initial treatment. The mean best-corrected visual acuities (BCVA) for typical AMD (tAMD; 0.688 ± 0.498) and polypoidal choroidal vasculopathy (PCV; 0.451 ± 0.395) were significantly less at 2 years (tAMD, 0.779 ± 0.632, P < 0.05; PCV, 0.534 ± 0.618, P < 0.05) and at 5 years (AMD, 0.873 ± 0.718, P < 0.05; PCV, 0.635 ± 0.668, P < 0.05) than at baseline. In eyes with tAMD, absence of blocked fluorescence was associated with 5-year maintenance of the baseline BCVA. Regarding PCV, the presence of polypoidal lesions and cystoid macular edema as well as the lesion size was associated with 5-year maintenance of the baseline BCVA. In some patients, the diagnosis changed: of the 192 eyes initially diagnosed with typical AMD, 19 were newly diagnosed with PCV during follow-up.
Maintaining the baseline BCVA over the long term is difficult in Japanese eyes with wet AMD.
KeywordsAge-related macular degeneration Photodynamic therapy Polypoidal choroidal vasculopathy Prospective study Visual prognosis
We are grateful to all patients and coinvestigators for their cooperation for the current study. Principal investigator Nagahisa Yoshimura (Kyoto University Hospital). Co-principal investigator Tatsuro Ishibashi (Kyushu University Hospital) and Mitsuko Yuzawa (Surugadai Nihon University Hospital). Research sites and investigators Sapporo City General Hospital, Hokkaido (Muneyasu Takeda, Hiroko Imaizumi, Utako Okushiba); Hirosaki University Hospital, Aomori (Mitsuru Nakazawa, Yukihiko Suzuki); Yamagata University Hospital, Yamagata (Hidetoshi Yamashita, Daijiro Tsuchiya); Gunma University Hospital, Gunma (Shoji Kishi, Ryo Mukai, Maki Takahashi, Taku Sato, Hidetaka Matsumoto); Tokyo Medical University Ibaraki Medical Center, Ibaraki (Masahiro Miura); Surugadai Nihon University Hospital, Tokyo (Mitsuko Yuzawa, Ryuzaburo Mori); Tokyo University Hospital, Tokyo (Yasuhiro Tamaki, Ryo Obata, Yasuo Yanagi); Tokyo Medical University Hospital, Tokyo (Takuya Iwasaki, Yasuyuki Yamauchi); Yokohama City University Medical Center, Kanagawa (Kazuaki Kadonosono, Maiko Inoue, Misa Suzuki); Seirei Hamamatsu General Hospital, Shizuoka (Akira Obana); Fujita Health University Hospital, Aichi (Masayuki Horiguchi, Atsuhiro Tanikawa); Kyoto University Hospital, Kyoto (Nagahisa Yoshimura, Akitaka Tsujikawa, Hideo Nakanishi, Yumiko Akagi-Kurashige, Kenji Yamashiro, Atsushi Otani, Hiroshi Tamura, Ayako Takahashi, Akio Oishi); Osaka University Hospital, Osaka (Fumi Gomi, Miki Sawa); Osaka Medical College Hospital, Osaka (Tsunehiko Ikeda, Masahiro Minami); Kansai Medical University Hospital, Osaka (Kanji Takahashi); Kansai Medical University Takii Hospital, Osaka (Kenichiro Sho); Kobe University Hospital, Hyogo (Shigeru Honda); Kagoshima University Medical and Dental Hospital, Kagoshima (Taiji Sakamoto, Akiko Okubo). The authors also thank the following additional investigators of the Translational Research Informatics Center for their contributions to this trial: Emiko Uno for data management; Yasuko Kimura for project management; and Hideaki Kaneda, Mikio Yoshidomi, Shinsuke Kojima, and Atsuhiko Kawamoto for manuscript review.
Conflicts of interest
Y. Akagi-Kurashige, None; A. Tsujikawa, Grant (Alcon, AMO Japan, Bayer, HOYA, Kowa, Novartis, Pfizer, Santen, Senju), Lecture fees, (Alcon, AMO Japan, Bayer, Chugai, Kowa, Nidek, Novartis, Pfizer, Santen, Sanwa Kagaku, Senju); M. Yuzawa, Grant (Alcon Japan, Santen), Consultant fees (Alcon Japan, Astellas Pharma, Janssen Japan), Lecture fees (Astellas Pharma, Bausch & Lomb Japan, Bayer, Japan Focus Company, Novartis, Santen, Senju); T. Ishibashi, None; H. Nakanishi, None; E. Nakatani, None; S. Teramukai, Grant (Daiichi Sankyo), Consultant fee (Daiichi Sankyo, Sanofi, Solasia Pharma, Sysmex, Taiho Pharmaceutical), Lecture fees (Bristol-Myers Squibb, Fujifilm); M. Fukushima, None; N. Yoshimura, None.
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