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Schaal, Shlomit MD, PhD; Sherman, Mark P. MD; Nesmith, Brooke MD, JD; Barak, Yoreh MD

doi: 10.1097/IAE.0000000000000981
Original Study

Purpose: To compare functional and anatomical responses to intravitreal bevacizumab in patients with exudative age-related macular degeneration (AMD) between two groups of patients with obstructive sleep apnea (OSA) with and without treatment with continuous positive airway pressure therapy.

Methods: Patients with OSA were categorized into 2 groups: 18 untreated and 20 treated with continuous positive airway pressure therapy. All patients had exudative AMD and received treatment with intravitreal bevacizumab. Central retinal thickness was plotted against time to assess anatomical response. Logarithm of the minimum angle of resolution visual acuity changes determined functional effect. Total number of intravitreal injections administered was assessed.

Results: Treated OSA group received 8 ± 7 total injections; untreated OSA group received 16 ± 4 injections (P < 0.05). Treated OSA group achieved statistically significant better visual acuity (logarithm of the minimum angle of resolution, 0.3 ± 0.24, 20/40), as opposed to the untreated group (logarithm of the minimum angle of resolution, 0.7 ± 0.41; P < 0.05). Central retinal thickness improved in the treated OSA group compared with the untreated group: 358 ± 95 μm to 254 ± 45 μm and 350 ± 75 μm to 322 ± 105 μm, respectively (P < 0.05, 20/100).

Conclusion: Untreated OSA hinders the response of exudative AMD to intravitreal bevacizumab. Treatment of OSA with continuous positive airway pressure therapy yields a subsequent anatomical response and functional improvement while requiring significantly less injections. Identifying and treating underlying OSA earlier in patients with exudative AMD may yield better functional outcomes.

Many patients do not respond or only partially respond to anti–vascular endothelial growth factor for the treatment of exudative age-related macular degeneration. Patients with exudative age-related macular degeneration and treated obstructive sleep apnea have better functional and anatomical response to anti–vascular endothelial growth factor therapy, and they require fewer injections than those with untreated obstructive sleep apnea.

*Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky; and

Department of Ophthalmology, Rambam Medical Center, Haifa, Israel.

Reprint requests: Shlomit Schaal, MD, PhD, 301E Muhammad Ali Boulevard, Louisville, KY 40202; e-mail:

Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY.

Meeting Presentations: ARVO annual meeting, Florida, May 2012 (Selected as “Hot Topic”), Macula Society annual meeting, Florida, February 2014, World Ophthalmology Congress, Tokyo, April 2014, ARVO annual meeting, Colorado, May 2015 (Selected as “Hot Topic”).

None of the authors have any conflicting interests to disclose.

© 2016 by Ophthalmic Communications Society, Inc.