Abstract
Purpose :
Visual acuity (VA) requirements for drivers in the US vary, with most states requiring a minimum Snellen VA of 20/40 in the better-seeing eye. We compared treatment (tx) patterns and VA outcomes in patients (pts) with nAMD or DME receiving anti-vascular endothelial growth factor (VEGF) IVT, and characterized the likelihood of pts to maintain vision following yr 1, specifically VA needed to drive over 4yrs.
Methods :
Electronic health record data (Vestrum Health; 01-01-2014 to 06-30-2020) for tx naïve pts at index (i.e. first tx) were analyzed. Number of IVT and VA yr over yr (YoY) were evaluated for pts with nAMD and DME, and by baseline VA. A Kaplan Meier curve was used to assess likelihood of losing “driving vision”, defined as first VA <20/40 sustained for ≥6 months in the treated, better-seeing eye (≥20/40). Pts were censored at end of follow up or date of event and grouped into high frequency IVT (HFI; ≥8) and low frequency IVT (LFI; 1–7) groups.
Results :
On average, nAMD pts received ~1.5 more injections vs DME pts in any given yr. In yr 1, pts with nAMD and DME gained 8.5 and 9.5 Early Treatment Diabetic Retinopathy Study letters, respectively. In yrs 2-4, nAMD pts experienced YoY losses of 1.9, 2.2 and 2.5 letters, respectively, while DME pts lost 1.1, 0.7 and 0.9 letters. Overall, from yr 1 to yr 4, pts with nAMD and DME lost 6.6 and 2.7 letters, respectively. nAMD and DME pts with ≥20/40 VA at index gained 1.4 and 2.3 letters, respectively, while those with <20/200 gained >20 and >30 letters. However, pts with ≥20/40 VA maintained better overall vision throughout the study. After 4 yrs, 69% and 72% of pts with nAMD and DME were able to maintain driving vision. When stratified by number of IVTs received in yr 1, the HFI group was more likely to maintain driving vision vs the LFI group in pts with nAMD (Fig 1) and DME (Fig 2).
Conclusions :
Pts with nAMD and DME experience similar VA gains, which peak at yr 1, but consistently lose vision beyond yr 1. While nAMD pts had roughly their baseline VA at 4 yrs, pts with DME were able to maintain most vision gained. In pts with nAMD and DME, receiving ≥8 anti-VEGF IVTs reduced the risk of losing driving vision by 5-10% in following yrs.
This is a 2021 ARVO Annual Meeting abstract.