Vascular endothelial growth factors play a significant role in neovascular AMD (nAMD), diabetic macular edema (DME) and retinal vein occlusion (RVO) and anti-VEGF agents are the current standard of care for treating these diseases. Recently, researchers compared anti-VEGF’s effects on visual outcomes in each of these diseases and found that the therapy doesn’t affect each disease in the same way.
The retrospective analysis study included data from the Tasmanian Ophthalmic Biobank. The researchers examined median change in BCVA from baseline to 12 months after initial treatment for all three diseases, as well as final BCVA and central macular thickness (CMT).
They found that at 12 months, change in BCVA was significantly different among the three disease cohorts. DME had a lower median change than RVO (2 letters vs. 11 letters). CMT was also significantly different among the three groups. DME had the smallest reduction in CMT, followed by RVO (-54µm vs. -137µm).
The researchers noted two more significant differences among the three cohorts: final BCVA and total number of injections received. They found that baseline BCVA was a negative predictor of outcome and baseline CMT was a positive predictor. When adjusting for baseline BCVA and baseline CMT, an nAMD or RVO diagnosis was a predictor of visual improvement compared with a DME diagnosis.
The researchers concluded that nAMD, DME and RVO patients treated with anti-VEGF have significantly different outcomes, with DME patients experiencing the smallest vision gains of the three. Lower baseline BCVA was a predictor for improvement in vision while higher baseline CMT was a predictor for greater thickness reduction.
“All three diseases showed less vision improvement [in this real-world study] than randomized controlled trials testing the effectiveness of anti-VEGF therapy,” the researchers noted in their paper. “This phenomenon isn’t unique to our study, with similar findings reported in other real-world and observational studies. This could be because clinical trials have strict eligibility criteria, treatment and follow-up schedules and exclude patients with extremely poor baseline characteristics or comorbidities. We report similar predictors of visual outcome as the clinical trials (baseline BCVA and CMT)."
Gurung RL, FitzGerald LM, McComish BJ, et al. Comparing vision and macular thickness in neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion patients treated with intravitreal antivascular endothelial growth factor injections in clinical practice. BMJ Open Ophthalmol. 2021;6:e000749. [Epub ahead of print].