ASRS 2024: Real-world treatment outcomes from a study of patients with retinal vein occlusion

At this year's American Society of Retina Specialists (ASRS) meeting, the Eye Care Network spoke with consultant ophthalmologist Christiana Dinah, BSc, MB BS, MRes. Her presentation focused on real-world outcomes of anti-vascular endothelial growth factor (VEGF) therapies for patients with retinal vein occlusion.

Editor's note: The below transcript has been lightly edited for clarity.

Christiana Dinah, BSc, MB BS, MRes: Hi my name is Christiana Dinah. I'm a consultant ophthalmologist at London North West Trust, in London, United Kingdom. It is my pleasure to present, at ASRS 2024, our work on the real-world outcomes with anti-VEGF therapy in retinal vein occlusion in the United Kingdom. We know the retinal vein occlusion is a significant cause of visual impairment, being the second most common retinal vascular disease, second only to diabetic retinopathy. We are fortunate to have anti-VEGF therapy now, with significantly beneficial results in pivotal randomised controlled trials.

However, these results have often been difficult to translate in the real world. Additionally, there is sparse data on long-term, real-world outcomes with anti-VEGF therapy in the context of retinal vein occlusion. We extracted data from 16 geographically dispersed eye clinics in the United Kingdom. Our study included approximately 3500 patients in the [branch retinal vein occlusion] BRVO arm and a similar number in the [Central Retinal Vein Occlusion] CRVO arm, so this is quite a large sample size. However, the proportion with follow-up out to 5 years was closer to 500 eyes in each cohort. We included patients that were treatment-naive to any treat previous treatment for retinal vein occlusion, who had had at least 1 anti-VEGF therapy within the timeframe of the study, and had a minimum of 3 month follow-up and up to 60 months follow-up, and that is 5 years.

Importantly, in the United Kingdom at the moment, the only approved anti-VEGF therapies for retinal vein occlusions are aflibercept, ranibizumab and bevacizumab. So these were the anti-VEGF therapies that we looked at, as under the umbrella of anti-VEGF. To our results, there was significant visual gain, with the average visual acuity gain of approximately 11 to 13 letters in both the branch retinal vein occlusion groups and the central retinal vein occlusion groups. And this was demonstrated quite early, within 3 months, and maintained up to around 12 to 18 months, at which point the visual acuity gains start to reduce slowly, and by the time we get to month 60, that is 5 years, the visual gains at that point is approximately 7 to 8 letters, almost half of the initial gains. We next looked at the number of injections delivered on average in the first year. In both the BRVO cohort and the CRVO cohorts a mean number of 6.4 to 6.5 injections were delivered. And this reduced over the follow-up period to approximately 2.5 injections in both cohorts in the year 5.

We delved deeper by stratifying the cohorts into low injection receivers, medium injection receivers and high injection receivers. The low cohort received less than 4 injections in within a 12 month period, the medium 4 to 8, and the high greater than 8 injections, and we demonstrated the high cohort reported visual gains similar to what we've seen in the clinical trials that into 15 letter gains, whilst the low cohort reported approximately half of that, and this pattern was evident right out to month 60. Additionally, eyes receiving intravitreal steroids and macular laser increased gradually from year 1 through to year 5, suggesting efforts to achieve or maintain disease control right out to year 5.

Our study strengths include a large heterogeneous population in a geographically dispersed population across United Kingdom, but limitations include the lack of anatomical data, in addition to a loss to follow-up, whereby the proportion of eyes at the start is approximately 3500 in the BRVO, and in the CRVO, separately whilst at year 5, we have approximately 500 eyes in each arm. The take home message is anti-VEGF therapy does work in retinal vein occlusion and translates into the real-world. However, there are factors limiting our ability to deliver the same volume of injections, as in the randomised control trials. Therefore, there's an unmet need for sustained durable treatments for retinal vein occlusions and long-term monitoring to ensure disease control. Thank you.