Abstract
Purpose :
Vision loss secondary to retinal vein occlusion (RVO) can impair driving ability. Minimum visual acuity (VA) requirements for driving varies by location but most states require Snellen VA of at least 20/40 in the better-seeing eye. We evaluated treatment patterns and rate of driving vision loss in a large cohort of patients with branch RVO (BRVO) and central RVO (CRVO) receiving anti-vascular endothelial growth factors (VEGF) injection
Methods :
In this retrospective study we used the electronic health record data from the Vestrum Health (01-01-2014 to 12-31-2021). We included patients who were treatment naïve at index date. Number of anti-VEGF injections and VA year-over-year were analyzed. Kaplan Meier analysis was used to evaluate the likelihood of driving-vision loss, defined as VA<20/40 for at least 3 months in the treated eye. We excluded patients with no VA data available at baseline and patients with less than 1 year follow-up.
Results :
A total of 4,306 patients (71.2% with BRVO) were included in the study. Both groups received a similar number of injections in the first year (6.27 injections in BRVO and 6.30 injections in CRVO). At the end of year 1, patients with BRVO gained an average of 13.17 Early Treatment Diabetic Retinopathy Study (ETDRS) letters and CRVO patients gained an average of 12.02 ETDRS letters. Between years 2 and 3, BRVO and CRVO patients lost 2.0 and 2.04 letters, respectively. At the end of year 1, BRVO and CRVO patients with good index vision (≥20/40) gained 1.5 and lost 1.9 letters, respectively and patients with poor index vision (VA <20/200) gained 39.3 letters (BRVO) and 26.2 letters (CRVO). However, patients with better index VA maintained better vision throughout the follow-up period. By the end of year three, 12.42% and 17.54% of patients with BRVO and CRVO lost driving vision. When categorized by number of injections performed at year 1, the patients receiving 4-7 injections were more likely to lose driving vision compared to the patients receiving >8 injections (10.59% vs. 9.09% in BRVO and 17.86% vs. 15.90% in CRVO).
Conclusions :
Patients with BRVO and CRVO receiving anti-VEGF injections experience VA gains which peak at year one but lose vision afterwards. More patients with CRVO loose driving ability compared to BRVO patients. Patients receiving >8 injections in year 1 are at lower risk of losing driving vision in the following years.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.