Visual acuity outcomes and anti-VEGF therapy intensity in macular oedema due to retinal vein occlusion: a real-world analysis of 15 613 patient eyes

Abstract

Background/AimsTo assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) therapy intensity in retinal vein occlusion (RVO)-related macular oedema (ME).MethodsA retrospective study was completed in treatment-naïve patients with RVO-related ME from 2013 to 2019, using the Vestrum Health Retina Database.ResultsMean baseline age was 72.4 years and 54% were women. In 6 months, in 8876 eyes with branch retinal vein occlusion (BRVO)-related ME, after a mean of 4.5 anti-VEGF injections, VA increased by 9.4 letters (95% confidence interval (CI) for change in VA +8.94 to +9.78, p<0.001) from a baseline of 55.1 letters. In 6737 eyes with central retinal vein occlusion (CRVO)-related ME, after a mean of 4.6 anti-VEGF injections over 6 months, VA improved by 9.2 letters (95% CI +8.50 to +9.87, p<0.001) from a baseline of 37.2 letters. In 1 year, VA gain was similar (BRVO: 7.4 injections, +8.1 letters, 95% CI +7.55 to +8.57, p<0.001; CRVO: 7.6 injections, +7.1 letters, 95% CI +6.31 to +7.95, p<0.001). In 6 months and 1 year, mean letters gain increased with number of anti-VEGF injections. Patient eyes with baseline VA of 20/40 or better tended to lose VA in 1 year.ConclusionMean change in VA correlates with treatment intensity, but patients with better VA at presentation are susceptible to vision loss, reflecting a ceiling effect. Assessed with the same database, VA gains compare favourably with 1-year VA gains in neovascular age-related macular degeneration and diabetic ME, but exhibit a larger gap when compared with corresponding randomised controlled trials.

Background Factors Affecting Visual Acuity at Initial Visit in Eyes with Central Retinal Vein Occlusion: Multicenter Study in Japan

“…In this multicenter study, we examined the baseline factors of patients with CRVO in Japan, and sought to determine the factors that were significantly associated with the BCVA at the initial examination. The baseline factors of the patients with CRVO were similar to recent real-world data of CRVO: the average age of the patients was about 70 years, and the patients had a higher prevalence of hypertension [13,15,19,26,27].…”

Background factors affecting visual acuity at initial visit in eyes with central retinal vein occlusion: multicenter study in Japan

“…The background characteristics of the patients with CRVO were similar to recent real-world data of CRVO: the average age of the patients was about 70 years and patients had a high prevalence of hypertension. 13,15,19,21,22 In our CRVO cohort, there were signi cantly more men (57.3%) than women (42.7%, P<0.001, Table 1). Another recent study of CRVO in Japan also showed that the prevalence was higher in men (64.7%) than women (35.3%), 19 whereas the global epidemiological studies have shown that the prevalence of CRVO did not differ signi cantly between sexes.…”

“…Another recent study of CRVO in Japan also showed that the prevalence was higher in men (64.7%) than women (35.3%), 19 whereas the global epidemiological studies have shown that the prevalence of CRVO did not differ signi cantly between sexes. 5,7 Recent real-world reports of CRVO in USA, 15 UK, 21 and Germany 13 also reported almost equal prevalence of CRVO between men and women. We presume that the higher prevalence of CRVO in men may be related to higher prevalence of hypertension and smoking rate of men in Japan.…”

“…However, the visual prognosis of CRVO is still not any better than that for branch retinal vein occlusion (BRVO). [13][14][15] It is known that the baseline best-corrected visual acuity (BCVA) is the strongest predictor for the nal BCVA in eyes with CRVO. [16][17][18][19][20] However, a PubMed search did not extract any study examining the background factors of the patients that were signi cantly associated with poorer BCVAs at the initial visit to the hospital.…”

Suprachoroidal Delivery of Small Molecules, Nanoparticles, Gene and Cell Therapies for Ocular Diseases

“…It is estimated that 24.4 million IVT injections were performed globally in 2019 with 6.9 million of these injections performed in the United States, most often for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) [5]. While IVT injections of anti-vascular endothelial growth factor (anti-VEGF) therapies are commonly performed in an office setting, and have demonstrated remarkable therapeutic benefits in controlled clinical trials [6][7][8][9][10][11][12][13][14][15][16][17], real world data on patients receiving IVT injections of anti-VEGF therapies show a much more modest improvement in patients' vision [18][19][20][21][22]. This disparity may relate to treatment burden, with patients undertreated due to an inability to maintain the frequent treatments in fixed regimens utilized in clinical trials.…”