June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Longer term Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular AMD, Diabetic Macular Edema and Retina Vein Occlusion–Related Macular Edema: A Real World Analysis of 130,247 Patient Eyes
Author Affiliations & Notes
  • Thomas A Ciulla
    Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, United States
    Retina, Midwest Eye Institute, Indianapolis, Indiana, United States
  • John Pollack
    Ophthalmology, Rush University Medical Center, Chicago, Illinois, United States
  • David Williams
    Ophthalmology, University of Minnesota Academic Health Center, Minneapolis, Minnesota, United States
  • Footnotes
    Commercial Relationships   Thomas Ciulla, Clearside (E), Clearside (I), Clearside (S); John Pollack, Neurotech (E), Neurotech (I), Vestrum Health (I); David Williams, Vestrum Health (I)
  • Footnotes
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Investigative Ophthalmology & Visual Science June 2021, Vol.62, 452. doi:
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      Thomas A Ciulla, John Pollack, David Williams; Longer term Visual Acuity Outcomes and Anti-Vascular Endothelial Growth Factor Therapy Intensity in Neovascular AMD, Diabetic Macular Edema and Retina Vein Occlusion–Related Macular Edema: A Real World Analysis of 130,247 Patient Eyes. Invest. Ophthalmol. Vis. Sci. 2021;62(8):452.

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

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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.

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