Abstract
Purpose :
Macular edema from retinal vein occlusions (MEfRVO) is a prevalent cause of vision loss treated by intravitreal anti-VEGF. Current literature suggests variances in treatment outcomes based socioeconomic risk factors. In this study, we investigate the impact of socioeconomic status as defined by the Area Deprivation Index on the efficacy of bevacizumab injections in MEfRVO.
Methods :
This is a retrospective cohort analysis including anti-VEGF naïve patients over a 10-year interval who received intravitreal bevacizumab for macular edema secondary to any retinal vein occlusion. We assessed best corrective visual acuity, central macular thickness (CMT), total macular volume (TMV) at baseline and at follow up intervals after injection. We controlled for age, sex, race, ethnicity, type of retinal vein occlusion, hemoglobin A1c, baseline vision/CMT/TMV, and presence of hypertension, hyperlipidemia, diabetes. Subject addresses were used to calculate Area Deprivation Index (ADI) and were categorized into low disadvantage (state ADI decile from 1 to 5) or high disadvantage (state ADI decile from 6 to 10) cohorts. Odds of visual acuity was analyzed via multivariate logistic regression and mean change in CMT and TMV was analyzed via multivariate linear regression to compare treatment responses among the two ADI cohorts after one and three injections.
Results :
147 individuals were included for the single injection analysis and 96 individuals were included at the three injection analysis. When comparing patients with a high versus low Area Deprivation Index score, there were no significant differences in the odds of visual acuity improvement (1-injection: OR=2.02, p=0.085; 3-injection: OR=1.16, p=0.810), percent reduction in CMT (1-injection: -25.5 vs -31.6, p=0.265; 3-injection: -24.8 vs -31.7, p=0.375), and percent reduction in TMV (1-injection: -19.1 vs -17.4, p=0.834; 3-injection: -14.9 vs-14.2, p=0.695).
Conclusions :
This study demonstrates that socioeconomic disparity modeled by Area Deprivation Index was not an independent risk factor on visual or anatomic responses to either a single or three injection course of bevacizumab in MEfRVO. While further studies are warranted, this finding is particularly interesting as it highlights similar treatment outcomes among different groups with bevacizumab which has strong utility in treating socioeconomically disadvantaged populations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.