Effects of Smoking on Outcomes of Antivascular Endothelial Growth Factor Therapy in Patients with Neovascular Age-Related Macular Degeneration Smoking and Anti-VEGF Therapy in nAMD

PURPOSE: To evaluate the effect of smoking on the outcome of antivascular endothelial growth factor (VEGF) therapy in patients with neovascular age-related macular degeneration (nAMD). METHODS: This retrospective case-control study included 64 eyes in 59 patients with treatment-naïve nAMD. Smoking habits were obtained from hospital records and patient recall. The patients were divided into ever-smokers and never-smokers. The patients were treated with ranibizumab or aflibercept for at least 1 year. Outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, subfoveal choroidal thickness (SCT), and number of injections received. RESULTS: There were no statistically significant differences in BCVA, CRT, or SCT changes between ever-smokers and never-smokers. The number of injections received was significantly higher in ever-smokers with a history of heavy smokers (never-smokers vs. heavy smokers: 5.3 ± 2.6/year vs. 7.3 ± 2.5/year; P=0.048 and mild smokers vs. heavy smokers: 5.2 ± 2.5/year vs. 7.3 ± 2.5/year; P=0.043). There was no significant difference in the baseline CRT or presence of atrophic retinal pigment epithelium in the fellow eyes of patients with nAMD according to smoking status; however, the baseline CRT in eyes with nAMD was significantly thinner in ever-smokers than in never-smokers (P=0.02). CONCLUSION: The anti-VEGF therapy was frequently required in nAMD patients with a history of heavy smoking. Heavy smoking could cause poor therapeutic response in nAMD patients.