Abstract
Purpose :
Anti-VEGF therapy is the gold standard for treatment of wet age-related macular degeneration (wet AMD). Currently, the choice of anti-VEGF drugs, number of injections, and their intervals vary among retina providers. This study investigates the difference in intravitreal injection practice patterns between retina providers in visual outcomes of wet AMD in a single hospital-based setting.
Methods :
Data from chart reviews of four retina practitioners between 2010-2020 at the University of Texas Medical Branch hospital were collected. Qualified subjects included a diagnosis of wet AMD (18-100 years) who received Bevacizumab, Ranibizumab, or Aflibercept eye injections. Each eye was counted separately, and eyes that switched providers were excluded. Patient demographics, ophthalmic clinical findings (visual acuity, IOP, macular thickness), and number and intervals of anti-VEGF injections were analyzed using Chi-squared and Kruskal-Wallis tests for quantitative variables.
Results :
The study included 182 eyes from 145 patients (80.5 yrs.), predominantly Caucasians (93.1%) and females (66.2%). A significant number of eyes received Bevacizumab (78%) over Ranibizumab (8%), with no significant difference in Aflibercept use (p=0.77) amongst all retina providers. Additionally, all providers had statistically significant differences in intravitreal injection regimens with respect to number of injections per eye (p=0.0001) and average intervals between injections (min 28 and max 45 days, p=0.002). However, there was no statistical difference in the number of injections needed to first achieve 20/30 or better visual acuity (p=0.80). Of note, 15.4% patients of Providers 1 & 2, 11% patients of Provider 3, and 7.1% patients of Provider 4 achieved 20/30 after a median number of injections of 9, 6, 2, and 2 at an average interval of 28, 30, 45, and 34 days respectively. Provider 1 had significantly better results compared to others, but when examining the overall effect, the providers were not significantly associated with visual acuity improvement after adjusting for all other clinical variables (p=0.13).
Conclusions :
Because significantly different intravitreal injection patterns resulted in similar visual outcomes, adopting a “best practice“ recommendation may decrease treatment and financial burden in wet AMD patients.
This is a 2021 ARVO Annual Meeting abstract.