Age Does Not Impact Anti-VEGF Treatment in Retinal Vein Occlusion

A female doctor examines the eye of a mature female patient.
Researchers show no differences in therapeutic responses across age groups.

The age of a patient with retinal vein occlusion (RVO) doesn’t impact their response to anti vascular endothelial growth factor (VEGF) therapy, according to a Cleveland-based research team. Their study, published in the Canadian Journal of Ophthalmology, found that, despite reductions in central subfield thickness (CST) and improvements in visual acuity (VA) across age groups, no notable differences in response to anti-VEGF application could be discerned. 

Investigators broke 295 participants into 4 groups by age. Group A (22 years to 61 years old) included 83 participants; Group B (61 years to 70 years old) included 69 participants; Group C (71 years to 79 years old) included 73 participants; and Group D (80 years to 95 years old) included 70 subjects. Participants’ age, race, sex, eye laterality and type of anti-VEGF medication they were also collected. 

The authors write, “The primary outcome was macular CST. Secondary outcomes were best corrected VA, cubic volume (CV), and cubic average thickness (CAT). The association between these outcome variables and relevant comorbidities, including obesity, diabetes, hypertension, heart disease, cerebrovascular accident (CVA), hyperlipidemia, and glaucoma, was also assessed.”

Mean baseline CST for groups A, B, C, and D was 406.3 (± 161.2) µm, 463.4 (± 165.5) µm, 470.6 (± 187) µm, and 427.3 (± 187.2) µm, respectively. No significant differences in CST were observed between groups at baseline, 6 months, or 12 months (P .08). Mean baseline VA for groups A, B, C, and D was 55.8 (± 19.5), 54.4 (± 19.8), 54.7 (± 19), and 51.4 ± 20.4 Early Treatment Diabetic Retinopathy letters, respectively. VA did not differ significantly between age groups at baseline, 6 months, or 12 months (P .06).

The report did find that central retinal vein occlusion (CRVO) patients younger than 61 years had lower baseline CST than those older than 71 years. CST also did not improve at 12 months from baseline in CRVO patients older than 80 years, and VA did not improve from baseline among CRVO patients older than 71 years. Baseline comorbidities were not predictive of worsened CST and VA outcomes between age groups. Branch retinal vein occlusion (BRVO), on the other hand, did see a CST decrease from baseline at 6 months, the study shows.

Prevalent around the world, RVO is the second most common retinal vascular disease and previous studies have indicated that as people get older, they have a higher chance of developing the disease. But prior literature shows little data on whether age is a predictive baseline factor for improvements of VA or decreases in macular thickness following anti-VEGF treatment.

Limitations in the study, however, impact its ability to provide strong evidence, the authors note. Because data was limited to what was available via electronic medical record and the sample size of younger participants was much smaller than the size of the older participants, results could have been skewed due to age distribution. 

While this study could not identify notable baseline age-related differences in either CST or VA overall, it did reveal differences in baseline CST among CRVO patients. The authors also note that their study likely uncovered a significant difference in baseline characteristics between CRVO and BRVO patients due to age.

This study was supported by Zeiss, Bausch + Lomb, Genentech/Roche, Alcon/Novartis, Regeneron Pharmaceuticals, Apellis, Graybug, and Ophthea.

Dewan K, Hentati F, Greenlee T, et al. Age-related differences in presentation and outcomes of anti-VEGF treatment of retinal vein occlusion. Canadian Ophthalmological Society. Published online October 21, 2020. doi: 10.1016/j.jcjo.2020.09.004