Comparison of Neovascular Age-Related Macular Degeneration Outcomes in Established vs New Patients of a Retina Practice

Du J, Chen MY, Dasan R, et al. Comparison of Neovascular Age-Related Macular Degeneration Outcomes in Established vs New Patients of a Retina Practice. Journal of VitreoRetinal Diseases. 2026;10(1):11-19. doi:10.1177/24741264251374576

Age-related macular degeneration (AMD) is a leading cause of blindness in the United States, and the development of choroidal neovascularization (CNV) – the “wet” or neovascular form of AMD – can lead to rapid, permanent vision loss if not treated promptly. Anti-VEGF therapy is the cornerstone of treatment, and prior research has established that earlier treatment initiation correlates with better visual outcomes. This retrospective cohort study from the Retina Group of Washington investigated whether patients with dry AMD who were already established under the care of a retina specialist fared better at the time of neovascular conversion compared to patients newly referred from non-retina providers such as general ophthalmologists or optometrists.

The study reviewed electronic health records from March 2016 to March 2023, identifying 645 patients with newly diagnosed unilateral neovascular AMD who received anti-VEGF therapy with at least 12 months of follow-up. Group 1 consisted of 253 established retina patients who converted from dry to wet AMD while already under specialist care. Group 2 consisted of 392 patients referred from non-retina providers at the time of their new neovascular diagnosis. Primary outcomes included best-corrected visual acuity (BCVA) at 12 months and last follow-up, as well as the number of injections administered during the first year of treatment.

Established patients in Group 1 presented with meaningfully better vision at the time of neovascular conversion (20/50 vs. 20/80), were far less likely to have submacular hemorrhage (7.9% vs. 18.6%), and achieved superior visual acuity at both 12 months and last follow-up. Group 2 patients were also more likely to end up with severely impaired vision – they were more than twice as likely to have a visual acuity of 20/200 or worse at 12 months. Interestingly, despite their better outcomes, established patients required fewer injections in the first year (8.6 vs. 9.2), suggesting that earlier detection – not more aggressive treatment – drove the improved results.

The authors conclude that patients with dry AMD benefit significantly from being under the ongoing care of a retina specialist, who can detect neovascular conversion earlier through routine dilated exams and retinal imaging, often before patients become symptomatic. The study notes that 70.8% of established patients were diagnosed during a routine visit, underscoring the value of proactive monitoring. Key limitations include the retrospective design, the inability to capture time-to-referral data, the absence of neovascular lesion size measurements, and the fact that results come from a single large specialty practice and may not be fully generalizable. The authors advocate for referring dry AMD patients to retina specialists proactively, before vision-threatening complications develop.