September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Impact of initial visual acuity on anti-VEGF treatment outcomes in patients with macular edema secondary to retinal vein occlusions
Author Affiliations & Notes
  • Karen M Wai
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
    Case Western Reserve University School Of Medicine, Cleveland, Ohio, United States
  • Mehnaz Khan
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Fabiana Silva
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Sunil K Srivastava
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Justis P Ehlers
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Aleksandra Rachitskaya
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Peter K Kaiser
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Andrew Schachat
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Amy Babiuch
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Alex Yuan
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Rishi Singh
    Cole Eye Institute, Cleveland Clinic, Cleveland , Ohio, United States
  • Footnotes
    Commercial Relationships   Karen Wai, None; Mehnaz Khan, None; Fabiana Silva, None; Sunil Srivastava, Allergan (R), Bausch and Lomb (C), Bioptigen (P), Synergetics (P); Justis Ehlers, Bioptigen (P), Genentech (R), Leica (C), Synergetics (P), Thrombogenics (C), Thrombogenics (R), Zeiss (C); Aleksandra Rachitskaya, None; Peter Kaiser, Alcon (C), Allegro (C), Novartis (C), Thrombogenics (C); Andrew Schachat, None; Amy Babiuch, None; Alex Yuan, None; Rishi Singh, Alcon (C), Regeneron (C), Thrombogenics (C)
  • Footnotes
    Support   Prevent Blindness Young Investigator Student Fellowship Awards for Female Scholars in Vision Research
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Karen M Wai, Mehnaz Khan, Fabiana Silva, Sunil K Srivastava, Justis P Ehlers, Aleksandra Rachitskaya, Peter K Kaiser, Andrew Schachat, Amy Babiuch, Alex Yuan, Rishi Singh; Impact of initial visual acuity on anti-VEGF treatment outcomes in patients with macular edema secondary to retinal vein occlusions. Invest. Ophthalmol. Vis. Sci. 201657(12):.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Clinical trials have shown that agents inhibiting vascular endothelial growth factor (VEGF) produce satisfactory outcomes in patients with macular edema secondary to retinal vein occlusions (RVO) albeit in a narrow visual acuity range. This retrospective study determined the impact of initial visual acuity on real world anti-VEGF treatment outcomes in patients with RVO.

Methods : An IRB approved analysis was conducted. 177 patients with macular edema secondary to hemi-retinal vein occlusions (HRVO), central retinal vein occlusions (CRVO), or branch retinal vein occlusions (BRVO) treated with anti-VEGF were identified. Exclusion criteria included prior treatment for macular edema such as intravitreal injections or presence of comorbid ocular disease. Patients were treated by investigator discretion until anatomically 'dry' by optical coherence tomography. Patients were grouped by initial visual acuity; main outcomes measured were mean change in best-corrected visual acuity (BCVA) and mean change in central subfield thickness (CST) at 6 and 12 months.

Results : CRVO/HRVO patients with initial BCVA of 20/40 or better showed little change in BCVA and CST after 6 months (-6.7 letters, p=0.15; -90.95μm, p=0.03) and 12 months (-9.6 letters, p=0.14; -47.92μm, p=0.38) of anti-VEGF therapy. Patients with initial BCVA of 20/50-20/300 showed greater improvement at 6 months (+10.1 letters, p=0.001; -172.69μm, p<0.001) and 12 months (+9.4 letters, p=0.016; -160.87μm, p<0.001). CRVO/HRVO patients with initial BCVA of 20/320 or worse showed the most improvement in BCVA and CST at 6 months (+33.8 letters, p<0.001; -192.67μm, p<0.001) and 12 months (+42.2 letters, p<0.001; -182.84μm, p=0.004). BRVO patients with initial BCVA of 20/40 or better had no significant changes in BCVA or CST at 6 months (+3.3 letters, p=0.21; -28.54μm, p=0.28) or 12 months (+2.6 letters, p=0.42; -48.94μm, p=0.12) after anti-VEGF therapy compared to patients with initial BCVA of 20/50-20/300 after 6 months (+11.8 letters, p<0.001; -102.87μm, p<0.001) and 12 months (+13.2 letters, p<0.001; -98.20μm, p<0.001). A study drawback is that treatment frequency was determined by investigator discretion rather than protocol.

Conclusions : For macular edema secondary to RVO, patients with worst initial visual acuities have the greatest potential improvement in terms of change in BCVA and CST with anti-VEGF treatment.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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