For the treatment of retinal vein occlusion (RVO), including branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO), using anti-VEGF agents is common practice, but individual success is dependent on the continuation of treatment. Results of this recent study demonstrate the effectiveness of anti-VEGF injections and their ability to improve and maintain positive visual outcomes even years down the line.

The researchers looked at data from 221 patients and 221 eyes that had been diagnosed with RVO and received treatment with anti-VEGF agents between 2009 and 2011. A total of 95 of the participants had BRVO, while 126 had CRVO. The mean age of patients was 65. Of those treated, 94 had completed eight years of therapy and were receiving an average of four injections in the eighth year. The average number of injections for the first year of treatment was just under seven. 

For those who followed up with appointments all eight years, vision improved by 18 letters by the one-year follow-up and 16 letters after eight years. The overall mean VA improved from baseline by 16.9 letters (eyes with BRVO went from an average of 60.5 to 74.8 letters; for eyes with CRVO, average VA went from 52 to 66.4). 

Participants who experienced the most significant improvement in vision at the eight-year mark often had poorer baseline vision and were younger. However, those with poor baseline VA still did not catch up to those who had better vision from the start. 

“Patients maintained a gain of 3-lines of vision 8-years after the commencing therapy,” the researchers noted in their paper. The results of the study are more encouraging than those on long-term outcomes of nAMD, which show initial gains being lost over time. “The initial gains at 1-2 years after starting treatment for nAMD are generally lost with vision returning to baseline or worse by 5-7 years. In contrast, we have demonstrated significant vision gained 8 years of treatment with anti-VEGF.”

One of the limitations of this study is that although many more people are diagnosed with BRVO, there were more participants with CRVO included. Another limitation is the high loss to follow-up rate, as not even half the participants kept up with eight years of treatment. More likely than not, RVO patients who receive consistent anti-VEGF injections will experience positive and maintained visual and anatomic outcomes, so remember to encourage your patients to keep up with their treatment regime. 

Spooner KL, Fraser-Bell S, Hong T, et al. Long-term outcomes of anti-vegf treatment of retinal vein occlusion. Royal College of Ophthalmologists. June 11, 2021. [Epub ahead of print].