Visual prognosis has changed dramatically for AMD patients since anti-VEGF therapy was introduced in the mid-2000s. As visual performance is a vital component of driving aptitude, researchers investigated how road-worthy acuity was affected in patients with neovascular AMD who began intravitreal anti-VEGF regimens.

In this retrospective cohort study of 416 individuals, patients with wet AMD treated with anti-VEGF PRN were followed for four years. Monocular best-corrected visual acuity (BCVA) measured using ETDRS was performed on the treated eye at all visits and on the fellow eye at baseline every six months, and upon any patient-reported change in vision. “Driving vision” was defined as BCVA in the better-seeing eye of greater than 70 ETDRS letters, corresponding to the minimum BCVA required in many countries.

Driving vision was present in 280 patients (67% of the total study population) and sustained in 86%, 74%, 65% and 59% of these individuals at one, two, three and four years, respectively. Lower BCVA in the better-seeing eye predicted loss of driving vision and higher BCVA was a significant predictor of capability to function behind the wheel.

The researchers said it’s important to note that dipping below the driving vision threshold during follow-up does not necessarily mean that the patient cannot regain it, as 59% of such patients were able to do so within one year.

In patients without driving vision at baseline, that level of performance was regained in 29%, 36%, 39% and 41% at one, two, three and four years, respectively; however, only 35% sustained driving vision after the first year.

“The prognosis is less encouraging for those without driving at baseline,” the authors noted in their study. “Lower age and higher BCVA in the best-seeing eye were both significant predictors of regaining driving vision.”

The study concludes driving vision can be sustained in the majority of the patients with neovascular AMD who commence intravitreal anti-VEGF if they have driving vision at baseline.