Abstract
Purpose :
Longer term “Real-world” visual acuity (VA) outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy were assessed in neovascular AMD (nAMD), diabetic macular edema (DME), branch and central retinal vein occlusion (BRVO, CRVO)-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 nAMD, DME, BRVO-ME and CRVO-ME patients who underwent anti-VEGF injections between 2014 and 2019 were eligible if follow up data was available through at least 12 months.
Results :
At 1, 3 and 5 years, in those 67,666, 21,305 and 5,208 eyes with nAMD, after a mean of 7.6, 19.5 and 32 injections, there was a mean change of +3.1, -0.2 and -2.2 letters respectively. At 1, 3 and 5 years, in those 40,832, 7,728 and 1,192 eyes with DME, after a mean of 6.2, 15.4 and 26.0 injections, there was a mean change of +4.7, +3.3 and +3.1 letters respectively. At 1 and 3 years, in those 12,451 and 3,027 eyes with BRVO-ME, after a mean of 7.1 and 18.2 injections, there was a mean change of +9.5 and +7.7 letters respectively. At 1 and 3 years, in those 9,298 and 2,264 eyes with CRVO-ME, after a mean of 7.3 and 18.8 injections, there was a mean change of +8.3 and +6.0 letters respectively. In all 4 conditions, mean letters gained increased with mean number of anti-VEGF injections at each of the aforementioned time periods. In all 4 conditions, patient eyes with baseline VA of 20/40 or better tended to lose VA, and those with progressively worse baseline VA experienced progressive greater gain in VA at 3 years.
Conclusions :
Real-world nAMD, DME, BRVO-ME and CRVO-ME patients experience meaningfully worse visual outcomes compared with patients in randomized controlled trials, with nAMD patients tending to lose VA at 3 and 5 years. Across all 4 disorders, mean change in VA correlates with treatment intensity at 1, 3 and 5 years. Patients with better VA at presentation tend to be particularly vulnerable to vision loss. There remains unmet need for more effective therapy with durability to address treatment burden.
This is a 2021 ARVO Annual Meeting abstract.