Vision Improvements Noted With Anti-VEGF Use, But Loss to Follow-Up is High

Patients with central retinal vein occlusion (CRVO) who received treatment with vascular endothelial growth factor (VEGF) inhibitors experienced visual acuity (VA) improvements at 3 years, according to research published in Ophthalmology Retina. However, a 50% loss to follow-up leads researchers to speculate that these VA findings may be worse, according to the report. While the choice of VEGF inhibitor affected central subfield thickness (CST), it did not affect VA. 

Researchers included 516 patients (eyes, 527; mean age, 71 years, 42% women) with CRVO from the Fight Retinal Blindness! registry in the retrospective, observational analysis. All patients underwent VA and central subfield thickness (CST) measurements. The research team recorded demographic factors, anti-VEGF treatments used, retinal vein occlusion type, and the presence of key risk factors. 

A total of 257 eyes (49%) achieved a follow-up of 1065 days or more (completers), while 270 eyes (51%) received less than 1065 days of follow-up (non completers). The mean VA change was +10 letters among the entire cohort. A total of 37% of eyes exhibited a final VA of 70 letters or better, while 30% experienced a loss of 35 letters or worse. The average CST experienced a 306 μm thinning. 

Stratified according to completion status, completers demonstrated a VA improvement of 12 letters, 324 μm CST thinning, and a median 18 anti-VEGF injections during 26 visits. Non completers experienced a VA improvement of 7 letters with 39% of participants gaining 15 or more letters. Mean CST thinning was 288 μm and a median 7 anti-VEGF injections were delivered during 18 months. 

The adjusted mean VA change was comparable among VEGF inhibitors regardless of a greater decrease in CST with aflibercept compared with ranibizumab or bevacizumab. Only 12% of patients exhibited resolution of macular edema without treatment during a 6 months period.

The researchers note the high loss to follow-up in the study. “This study illustrates the large investment in time and treatment required to achieve reasonable visual outcomes in patients with CRVO encountered in routine clinical practice,” according to the investigators. “ It appears that around half of patients starting injections for CRVO will still be needing them 3 years later to maintain their vision.”

Study limitations include a high loss to follow-up and retrospective nature.

Disclosure: This research was supported by Bayer and Novartis. Multiple study authors declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures.