According to a new study from the Wilmer Eye Institute at Johns Hopkins University, patients with branch or central retinal vein occlusion (BRVO, CRVO) showed large improvements in best-corrected visual acuity after initiation of anti-VEGF injections; however, some visual gains were lost in many patients over time due to recurrent edema. Like AMD, both BRVO and CRVO are chronic diseases that require many years of injections in most patients.

The study prospectively recorded the number of anti-VEGF injections and improvement from baseline BCVA and central subfield thickness in 40 eyes of 39 CRVO patients and 50 eyes of 47 BRVO patients. Mean follow up was 58 and 78 months for BRVO and CRVO, respectively. Within six months of the last follow up, 58% of BRVO patients and 75% of CRVO patients required anti-VEGF injections to control edema.

For BRVO patients, BCVA letter score increased by a mean of 24 from baseline of 52 (20/100) to a peak of 76 (20/32) and subsequently decreased to 63 (20/50) at final visit. CRVO patients gained a mean of 26 letters, from baseline of 48 (20/100) to peak of 74 (20/32), and subsequently decreased to 56 (20/80) at last follow up. Recurrent macular edema and the related foveal damage caused any loss from peak BCVA. Researchers noted that that loss of peak vision occurred in almost all patients. While it was greater in those with poor visual outcome, it still occurred in patients with good ones too.

Researchers suggest suppression of VEGF as an alternative approach to frequent injections to try and avoid recurrent edema. The vast majority of patients with RVO would benefit from a durable, sustained delivery treatment. Only 14% of BRVO patients and 20% of CRVO patients had edema resolution without a large number of injections. Therefore, after proof-of-concept is obtained for new treatments that provide sustained suppression of VEGF in patients with neovascular AMD, the researchers find it reasonable to test them in patients with RVO as well.

Iftikhar M, Mir TA, Hafix G, et al. Loss of peak vision in retinal vein occlusion patients treated for macular edema. Am J Ophthalmol. April 4, 2019. [Epub ahead of print].