Clinical practice outcomes worse than trial outcomes with anti-VEGF therapy in macular edema

A real-world analysis of longer-term outcomes for anti-VEGF therapy in clinical practice for patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), branch retinal vein occlusion (BRVO)- and central retinal vein occlusion (CRVO)- macular edema demonstrated meaningfully worse visual acuity outcomes compared to patients in randomized controlled trials, with nAMD patients losing visual acuity at 3 and 5 years. For all 4 disorders, mean change in visual acuity correlates with treatment intensity at 1, 3, and 5 years, and patients with better visual acuity at presentation appear to be particularly vulnerable to vision loss, according to a presentation of the ASRS 2021 Annual Meeting.

The retrospective analysis included data from US retina specialists and identified 130,247 patient eyes. Treatment-naïve nAMD, DME, BRVO-ME and CRVO-ME patients had received anti-VEGF injections between 2014 and 2019 and 12-month follow up data. In all 4 conditions, mean letters gained increased with mean number of anti-VEGF injections at each time period and patient eyes with baseline visual acuity of 20/40 or better tended to lose visual acuity, and those with worse baseline visual acuity experienced progressive greater gain in visual acuity at 3 years.

Reference
Ceola TA. Three- and 5-Year outcomes and anti-VEGF therapy intensity in neovascular AMD, DME and RVO–macular edema: a real-world analysis of 130,247 patient eyes. Presented at: 2021 Annual ASRS Meeting.