June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Macular Edema Due to Retinal Vein Occlusion: A Real World Analysis of 12,214 Eyes.
Author Affiliations & Notes
  • Thomas A Ciulla
    Retina, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Footnotes
    Commercial Relationships   Thomas Ciulla, Clearside (E), Clearside (I)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3523. doi:
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      Thomas A Ciulla; Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Macular Edema Due to Retinal Vein Occlusion: A Real World Analysis of 12,214 Eyes.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3523.

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

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Abstract

Purpose : “Real-world” visual acuity (VA) outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy were assessed in retinal vein occlusion (RVO)-related macula edema (ME).

Methods : A retrospective analysis was performed on a large database of aggregated, longitudinal, deidentified electronic medical records from a geographically and demographically diverse sample of patients of United States retina specialists (Vestrum Health Retina Database). Treatment naïve RVO patients with ME who underwent anti-VEGF injections between 2013 and 2019 were eligible if follow up data was available through 12 months.

Results : In those 5,300 eyes with central retinal vein occlusion (CRVO)-related ME, the mean age at presentation was 72.9 years and 51% were female. Mean baseline VA was 39.5 letters (20/160 Snellen equivalent). At 1 year, after a mean of 7.6 anti-VEGF injections, there was a mean gain of 7.1 letters (95% CI for change in VA, +6.31 to +7.95; P < 0.001). In those 6914 eyes with branch retinal vein occlusion (BRVO)-related ME, the mean age at presentation was 72.3 years and 56% were female. Mean baseline VA was 56.6 letters (20/80 Snellen equivalent). At 1 year, after a mean of 7.4 anti-VEGF injections, there was a mean gain of 8.1 letters (95% confidence interval [CI] for change in VA, +7.55 to +8.57; P < 0.001). These outcomes compare favorably to the 1-year real world outcomes for anti-VEGF therapy in neovascular age-related macular degeneration (49,485 eyes; 7.3 anti-VEGF injections/eye; +1.0 letter at 1 year; 95% CI for change in VA, +0.77 to +1.13 letter; P < 0.001) and diabetic macular edema (28,658 eyes; 6.4 anti-VEGF injections/eye; +4.2 letters at 1 year; 95% CI for change in VA, +3.97 to +4.48 letters; P < 0.001), using the same database. In RVO-related ME, there was a linear relationship between mean letters gained and mean number of anti-VEGF injections for both BRVO-related ME (R2 = 0.825) and CRVO-related ME (R2 = 0.615). Patient eyes with baseline VA of 20/40 or better tended to lose VA at 1 year.

Conclusions : Real-world RVO patients with ME experience worse visual outcomes compared with patients in randomized controlled trials. Mean change in VA correlates with treatment intensity at 1 year. Patients with better VA at presentation tend to be particularly vulnerable to vision loss.

This is a 2020 ARVO Annual Meeting abstract.

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