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Hitesh Chandwani, Ashley L Cole, Joanna Campbell, Herbert Ingraham, Arghavan Almony, Szilard Kiss, Steven Marks, Jonathan W Kowalski, Nancy M Holekamp; Real-World Vision Outcomes in RVO Treated With Anti-VEGF Injections- An Analysis of EMR Data From a Large Health System. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3919.
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Prior studies have demonstrated less frequent anti-vascular endothelial growth factor (anti-VEGF) utilization in retinal diseases in clinical practice compared with landmark randomized controlled trials (RCTs). The purpose of this study is to further examine vision outcomes in retinal vein occlusion (RVO) patients managed with intravitreal anti-VEGF therapy in clinical practice.
This is a retrospective analysis of electronic medical records from an integrated health system in the United States. The sample included eyes of RVO patients receiving initial treatment with intravitreal ranibizumab or bevacizumab from Jan 2007 to Feb 2013, with corrected visual acuity (CVA) from 20/40 - 20/400 at index treatment (baseline), and at least 3 months follow-up. Data missing due to missing visit, or invalid or missing CVA, were imputed using the last observation carried forward (LOCF) approach. Snellen visual acuities were converted to the ETDRS scale using a published algorithm. The number of anti-VEGF injections, change in CVA from baseline, and proportion of eyes improving ≥3 lines were assessed at 3, 6, and 12 months from the index anti-VEGF treatment. Analyses were performed on observed data and data imputed by LOCF.
Seventy-seven eyes met all inclusion criteria with mean (SD) CVA at baseline of 51.7 (15.4) letters. Of the 77 eyes, 71 and 63 eyes had follow-up through 6 and 12 months, respectively. At 3, 6 and 12 months: the mean numbers of anti-VEGF injections were 2.2, 3.0, and 4.5; mean CVA change from baseline was 11.4, 7.9, and 6.2 letters, using LOCF; and proportions of eyes gaining ≥3 lines were 41.6%, 35.2%, and 31.8% (Table 1).
In this large health care system retrospective analysis, frequency of intravitreal injections and subsequent visual acuity improvement in clinical practice are lower than that reported in landmark RCTs. Earlier studies demonstrating less frequent anti-VEGF injections than in RCTs hypothesized that less frequent injections might result in less visual acuity improvement than seen in RCTs. This study links less frequent utilization of anti-VEGF injections in RVO to less visual acuity improvement. Additional research is needed to assess the factors that may affect utilization of anti-VEGF injections and other patient characteristics differing from RCTs that may affect vision outcomes.
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