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Title: Predictors of persistent disease activity following anti-VEGF loading dose for nAMD patients in Singapore : the DIALS study
Authors: Tan, Colin Siang Hui
Lim, Louis W.
Ngo, Wei Kiong
Pannirselvam, Pandiyan
See, Clarence
Chee, Wai Kitt
Saxena, Nakul
Keywords: Science::Medicine
Issue Date: 2020
Source: Tan, C. S. H., Lim, L. W., Ngo, W. K., Pannirselvam, P., See, C., Chee, W. K., & Saxena, N. (2020). Predictors of persistent disease activity following anti-VEGF loading dose for nAMD patients in Singapore : the DIALS study. BMC Ophthalmology, 20(1), 324-. doi:10.1186/s12886-020-01582-y
Journal: BMC Ophthalmology 
Abstract: Background: To determine the frequency of persistent disease activity following 3 loading doses of anti- vascular endothelial growth factor (VEGF) agents, and the anatomic and demographic predictors of early persistent disease activity among patients with neovascular age-related macular degeneration (nAMD). Methods: In a retrospective real-world cohort study, 281 consecutive patients with nAMD were reviewed at baseline and after 3 anti-VEGF injections for pre-defined indicators of disease activity. Optical coherence tomography (OCT) features such as subretinal fluid, intraretinal cysts and intraretinal fluid were assessed by reading-center certified graders. Multiple logistic regression was performed on demographic and anatomic factors. Results: At month 3, 66.1% of patients had persistent disease activity. The best-corrected visual acuity (BCVA) improvement was 0.16 LogMAR for those with no disease activity compared to 0 for patients with persistent activity (p < 0.001). The significant risk factors for persistent activity at 3 months were male gender (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.32–0.93, p = 0.025), intraretinal cysts at baseline (OR 2.95, 95% CI 1.67–5.20, p < 0.001) and subretinal fluid at baseline (OR 3.17, 95% CI 1.62–6.18, p = 0.002). At 3 months, 58% of patients had features of activity on OCT. Patients with intraretinal cysts and intraretinal fluid at baseline had worse BCVA at month 3 compared to patients without these OCT features (0.69 vs. 0.43, p < 0.001, and 0.62 vs. 0.43, p < 0.001, respectively). Conclusions: In a real-world study, 66.1% of nAMD patients have persistent disease activity after the initial loading dose, with poorer BCVA compared to those without. Baseline OCT features (intraretinal cysts and subretinal fluid) are useful predictors of persistent disease activity at month 3.
ISSN: 1471-2415
DOI: 10.1186/s12886-020-01582-y
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © 2020 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Fulltext Permission: open
Fulltext Availability: With Fulltext
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