Visual Outcomes of Anti-VEGF Therapy Limited in Advanced Disease

Patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), branch and central retinal vein occlusion (BRVO, CRVO)-related macular edema (ME) experience limited visual outcomes with anti-vascular endothelial growth factor (anti-VEGF) therapy, according to a study in Ophthalmology Retina. Despite anti-VEGF therapy, patients with nAMD tend to lose vision at 3 and 5 years, the report shows. The study also found that across all 4 disorders, patients with better baseline vision tend to experience more vision loss, and injection frequency is associated with visual gains. 

Researchers retrospectively analyzed 130,247 eyes by using data from the Vestrum Health Retina Database. The analysis included patients with treatment naïve nAMD, DME, BRVO-ME and CRVO-ME who received anti-VEGF injections between 2014 and 2019, with follow-up data available through at least 12 months. Patients with other retinal diagnoses were excluded from the study. The main outcome measure was average VA change up to 3 years (BRVO-ME, CRVO-ME) and 5 years (nAMD and DME).

At 1, 3 and 5 years, in 67,666, 21,305 and 5,208 eyes with nAMD, after an average of 7.6, 19.5 and 32 injections, there was an average change of +3.1, -0.2 and -2.2 letters, respectively. At 1, 3 and 5 years, in 40,832, 7,728 and 1,192 eyes with DME, after an average of 6.2, 15.4 and 26.0 injections, there was an average change of +4.7, +3.3 and +3.1 letters, respectively. At 1 and 3 years, in 12,451 and 3,027 eyes with BRVO-ME, after an average of 7.1 and 18.2 injections, there was an average change of +9.5 and +7.7 letters, respectively. At 1 and 3 years, in 9,298 and 2,264 eyes with CRVO-ME, after an average of 7.3 and 18.8 injections, there was an average change of +8.3 and +6.0 letters, respectively. (P <.01 for all VA changes >1 letter), according to the report. 

In all 4 disorders, the researchers found that mean VA increased with the mean number of anti-VEGF injections. Eyes with baseline VA of 20/40 or better tended to experience VA loss and eyes with progressively worse baseline VA had progressively greater VA gain at 3 years, the team notes.  

Study limitations include the retrospective design, absence of atomic data and controls, decrease in follow-up over time, and non-standardized visual acuity assessment. 

“This analysis yields relevant insights on unmet need related to treatment burden with current medications, as the health care system adopts value-based approaches with increasing accountability for clinical practice outcomes,” according to the researchers. “There remains significant unmet need for more effective therapy with durability to address treatment burden.”

Disclosure: Some study authors declared affiliations with Vestrum Health. Please see the original reference for a full list of authors’ disclosures. 

Reference

Ciulla TA, Hussain RM, Taraborelli D, Pollack J, Williams DF. Longer term visual outcomes in neovascular amd, diabetic and vein occlusion related macular edema: clinical outcomes in 130,247 eyes. Ophthalmol Retina. Published online April 2, 2022. doi:10.1016/j.oret.2022.03.021