Posters Emphasize Prevalence and Need for Prompt Treatment of RVO

Posters presented at the American Academy of Ophthalmology conference revealed data on those most affected by retinal vein occlusion (RVO) in the United States and how to go about managing the disease.

The first poster¹ presented the results of a weighted analysis that used a multivariable regression model to find the risk factors and who was most affected by RVO, a significant cause of visual disability. The study included 5559 adults 40 years and older who participated in the Nutrition Health and Nutrition Examination Study and had retinal imaging. Photographs were graded by ophthalmologists to determine the presence of RVO.

There were 33 cases of RVO found in 5559 participants, 27 of which were branch RVO and 6 of which were central RVO. The prevalence rates of RVO, branch RVO, and central RVO in the United States were estimated at 0.50% (95% CL, 0.30%-0.71%), 0.42% (95% CL, 0.23%-0.60%), and 0.08% (95% CL, 0%-0.18%), respectively.

Significant risk factors for RVO were found to be age (odds ratio [OR], 1.93; 95% CI, 1.31-2.92 per 10-year increase) and an elevated diastolic blood pressure (OR, 1.47; 95% CI, 1.10-2.12 per 10 mm Hg increase). Race, sex, glaucoma, elevated cholesterol, and self-reported history of diabetes were not found to be risk factors for RVO.

The study had a cross-sectional design, which could not determine causality, and used questionnaires to obtain past medical history, which is subject to bias.

Despite this, the researchers concluded that RVO is associated with older age and elevated diastolic blood pressure, which could help to identify those most at risk for RVO in the future.

The second poster² focused on finding the best course of action for management of RVO. The post hoc analysis analyzed the impact of time on outcomes in macular edema following central RVO (MEfCRVO) and macular edema following branch RVO (MEfBRVO).

The study used data from 3 studies. COPERNICUS and GALILEO were randomized, multicenter, double-masked trials in treatment-naïve patients with MEfCRVO. These patients had a central subfield thickness (CST) greater than or equal to 250 mm and an Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA) of 20/40 to 20/320. VIBRANT was a randomized, multicenter, double-masked trial in treatment-naïve patients with MEfBRVO who had an ETDRS BCVA of 20/40 to 20/320.

In COPERNICUS, all patients received intravitreal aflibercept injection (IAI) of 2 mg on a PRN basis from week 24 to week 100. In GALILEO, patients received IAI 2 mg on an as-needed basis from week 24 to week 76 and the sham arm received IAI 2 mg from week 52 to week 76. In VIBRANT, patients in the IAI arm received IAI 2 mg every 8 weeks through week 48 and a rescue grid laser was given if needed at week 36. Eyes in the laser arm that were eligible for rescue treatment received IAI 2 mg every 8 weeks after 3 initial doses.

The COPERNICUS and GALILEO study participants were split into 3 groups based on time from diagnosis to treatment: less than 1 month, 1 to 3 months, and greater than 3 months. Participants in VIBRANT were split into 2 groups: less than 1 month and 1 month or more. Effect of baseline BCVA was assessed in 3 groups per study.

There were relatively more Hispanic patients in the COPERNICUS study who had waited more than 3 months from diagnosis to treatment, but the number of Hispanic participants was low across all 3 groups. GALILEO and VIBRANT had similar demographics across all time since diagnosis groups. The mean CST was lowest in those who waited more than 3 months from diagnosis to treatment in both the GALILEO and COPERNICUS studies. In the VIBRANT study, the proportion of patients who had a perfused retina was higher in those who had a time to treatment greater than 1 month.

A delay of greater than 3 months before the start of treatment was associated with less vision gain at week 24 compared with those receiving treatment within 1 month in both the COPERNICUS and GALILEO studies. The mean CST decreased to a similar extent across all groups.

In the VIBRANT study, a delay of greater than 1 month to start treatment was associated with less vision gain at weeks 24 and 52 compared with those treated within the month of diagnosis. The mean CST did decrease to the same extent in both diagnosis groups, however.

Patients with worse baseline BCVA in both MEfCRVO and MEfBRVO had greater visual improvement but had a lower mean final BCVA compared with patients who had better baseline BCVA.

The researchers concluded that these results highlighted the importance of prompt treatment for patients with MEfRVO and MEfCRVO.

References

1.Kalva P, Akram R, Zuberi H, Kooner K. The prevalence of and risk factors for retinal vein occlusion (RVO) in the U.S. from the national health and nutrition examination survey. Presented at: AAO 2022; September 30-October 3, 2022; Chicago, IL. Abstract PO426.

2. Sharma S. Impacts of time since diagnosis to anti-VEGF injection and baseline BCVA on outcomes in retinal vein occlusion (RVO). Presented at: AAO 2022; September 30-October 3, 2022; Chicago, IL. Abstract PO394.