Dilsher Dhoot, MD: Effect of Time to Aflibercept Injection on CRVO Outcomes


Longer time to intravitreal aflibercept injection (>3 months) showed less visual improvement versus shorter time (<1 month).

New findings suggest that a longer time to intravitreal aflibercept injection (>3 months) was linked to less visual improvement versus a shorter time (<1 month) after diagnosis of macular edema due to central retinal vein occlusion (CRVO).

Those patients with poor baseline best-corrected visual acuity (BCVA) additionally showed greater visual improvement, but worse mean final BCVA compared to patients with better baseline BCVA.

The findings were presented at the American Society of Retina Specialists 40th Annual Scientific Meeting.

In an interview with HCPLive, Dilsher Dhoot, MD, California Retina Consultants, discussed the post-hoc analysis of the pivotal phase 3 COPERNICUS and GALILEO trials which led to these findings.

“Our goal was to take a look at really two things, one was time to first treatment and its effect on visual anatomy,” Dhoot said. “And also baseline visual acuity and its effect on vision and anatomy.”

The first analysis broke patients down into three groups, to those who had been treated <1 month of diagnosis, 1 to 3 months of diagnosis, or >3 months of diagnosis with a full reset. The data show patients who had a delay in treatment had less improvement in VA than those without a delay following diagnosis.

“Interestingly, anatomic improvements were similar amongst both groups, despite the visual acuity changes,” Dhoot noted.

In terms of the second analysis, patients with the worst vision gained the most in terms of visual acuity, which Dhoot noted was expected due to the ceiling effect.

“Though, those patients who had the best visual acuity at baseline had the best visual acuity at the end of the trial,” Dhoot said. “Patients certainly with better vision do better long term.”

Dhoot added that it is crucial to manage patient and physician expectations and provide prognostic information. He said it is helpful to know that starting treatment earlier, rather than delaying it, is more beneficial for the patient and it is important to know that those with better vision at baseline, they’ll have better outcomes.

Dhoot also pointed out the importance of patient care education and educating patients on the needs and goals of these treatments may lead to better outcomes. He noted studies that looked at socioeconomic factors affected access to health care and the disparities faced in underserved populations.

“There is a disparity and unfortunately, that does result in vision left on the table,” he said. “I mean, having access to care and timely treatments, with the necessary medications is vital.

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