When the initial letter score was less than 69 ( approximately 20/50 or worse ) , the mean improvement was 18.9 with aflibercept , 11.8 with bevacizumab , and 14.2 with ranibizumab ( P < 0.001 for aflibercept vs. bevacizumab , P = 0.003 for aflibercept vs. ranibizumab , and P = 0.21 for ranibizumab vs. bevacizumab ) .