VEGF Inhibitor Choice Has Limited Effect on VA Outcomes for Patients with CRVO

Adrian Hunt, MBBS

New findings suggest patients with central retinal vein occlusion (CRVO) that began vascular endothelial growth factor (VEGF) inhibitors in routine care had visual acuity (VA) improvement of nearly 10 letters at the 3-year mark.

The study noted this almost matched the outcomes of extension studies that followed randomized controlled trials (RCTs).

“The choice of VEGF inhibitor influenced central subfield thickness (CST) but not VA outcomes,” wrote study author Adrian Hunt, MBBS, The University of Sydney Save Sight Institute. “Half of all eyes were still being treated at 36-months.”

These findings were presented at the Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting in Denver, Colorado.

Hunt and colleagues conducted a retrospective analysis of a large prospectively specified observational database of patients with CRVO treated with VEGF inhibition from routine practice. They identified a total of 527 treatment-naive patients with CRVO that commenced VEGF inhibitors between January 2010 - 2018, with a mean age of 71 years and visual acuity (VA) of 41 letters.

Their primary outcome was considered the mean change in VA from baseline to 36 months. Adjusted VA and central subfield thickness (CST) outcomes compared VEGF agents with generalized mixed effects models.

In all eyes, the mean VA change (95% CI) was 10 letters. Data additionally show 44% gained and 14% lost ≥15 letters, 37% had final VA ≥70 and 30% ≤35 letters. The mean CST change was -306 µm.

The study investigators also observed the adjusted mean VA change was similar with each VEGF inhibitor (12 letters) despite significant differences in adjusted mean CST change with aflibercept (-310 µm), ranibizumab (-258µm), or bevacizumab (-216 µm; P <.001).

Meanwhile, VEGF switchers (19%) gained 11 letters like non-switchers (69%), but with more injections (20 vs 10; P <.001). Data show eyes that were switched to steroids (12%) had lower mean baseline VA at 38 letters and 46% had final VA ≤35 letters and no mean change in VA from baseline.

The mean VA change in eyes with trial-eligible baseline VA (19 - 73 letters, 356/527, 68%) was noted to be 7 letters. Eyes outside this range with very-poor baseline (<19 letters, 129/527, 24%) gained 22 letters and eyes with very-good baseline VA (>73 letters, 42/527, 8%) lost vision by -7 letters.

Then, completers in the study (257/527, 49%) had a median of 18 injections over 26 visits. The suspension of therapy >180 days occurred in 141/527 (27%) eyes, but only 62 (12%) eyes had no macular edema during that time.

Investigators noted treatment status was known in 356/527 (68%) eyes. At the 3-year mark, 55% were still receiving injections, while 45% had suspended therapy.

The study, “36-month outcomes of VEGF inhibitors for treatment-naïve Central Retinal Vein Occlusion: Data from the Fight Retinal Blindness! Registry,” was presented at ARVO 2022.