Delayed Anti-VEGF Therapy May Not Affect Vision in RVO With Good Baseline Acuity

Delayed anti-vascular endothelial growth factor (anti-VEGF) treatment may not affect vision in individuals with macular edema secondary to retinal vein occlusion (RVO) and good baseline visual acuity (Snellen, 20/30 or better), according to a study published in Eye. 

Patients who underwent delayed anti-VEGF treatment (>30 days following diagnosis) experienced similar vision outcomes compared with individuals receiving immediate treatment (≤30 days following diagnosis) and those undergoing observation, the report shows. 

Researchers included 131 patients (mean age, 73.2 years; 50.4% women) presenting with macular edema secondary to RVO and good baseline vision between January 2012 and February 2021 in the retrospective analysis. Study participants underwent central subfield thickness (CST) and visual acuity measurements at baseline and during 6-, 12-, and 24-month follow-up visits. The research team compared visual outcomes between patients who received no treatment or immediate (n=43) or delayed (n=27) anti-VEGF treatment. 

Among the immediate and delayed anti-VEGF treatment recipients, patients received an average of 5.8 and 5.0 bevacizumab, 6.8 and 7.4 aflibercept, or 4.7 and 1.0 ranibizumab injections, respectively.

The percentage of patients with a best visual acuity of 20/25 or better was similar at baseline (60.7% vs 74.1% vs 95.6%; P =.431) and at 12 (52.5% vs 50.0% vs 46.9%; P =.894) and 24 months (51.7% vs 45.0% vs 53.8%; P =.829) among individuals receiving no treatment, delayed anti-VEGF treatment, and immediate treatment, respectively.

However, the percentage of patients who lost 5 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters between baseline and 6 months differed according to treatment. Individuals who underwent delayed anti-VEGF treatment (50.0%) were more likely to experience this loss compared with participants who received no treatment (23.9%) and patients receiving immediate treatment (18.2%). The delayed treatment group also had the highest percentage of individuals who lost 5 or more ETDRS letters (65.0%) during the course of the investigation, followed by the immediate treatment (30.8%) and no treatment groups (24.1%).

No significant differences among participants with a 10% or greater reduction in CST at the study conclusion were noted among the 3 cohorts.

“This study suggests that while some patients who delay anti-VEGF treatment can experience vision loss, overall visual acuity over two years is comparable between patients who receive immediate, delayed, or no anti-VEGF treatment,” according to the researchers. “Close observation with initiation of treatment when appropriate may be recommended in the setting of routine clinical practice for RVO patients with good vision at diagnosis.”

Study limitations include a retrospective design, small sample size, and short study duration. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.