Posters presented at the annual meeting of the American Academy of Ophthalmology showed that patients with retinal vein occlusion (RVO) are most likely older with higher diastolic blood pressure and require prompt treatment to help manage the disease.
Posters presented at the American Academy of Ophthalmology conference revealed data on who is most affected by retinal vein occlusion (RVO) in the United States and how to manage the disease.
The first poster1 presented the results of a weighted analysis that used a multivariate regression model to find risk factors and who was most affected by RVO, a major cause of visual impairment. The study included 5,559 adults 40 years and older who participated in the Nutrition Health and Nutrition Examination study and who underwent retinal imaging. The photographs were scored by ophthalmologists to determine the presence of RVO.
There were 33 cases of RVO found in 5559 participants, of which 27 were branch RVO and 6 were central RVO. The prevalence rates of RVO, branch RVO, and central RVO in the United States were estimated to be 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.
Age (odds ratio [OR], 1.93; 95% CI, 1.31-2.92 per increase over 10 years) and elevated diastolic blood pressure (OR, 1.47; 95% CI, 1.10-2.12 per 10 mm Hg increase) . Race, gender, glaucoma, high cholesterol, and self-reported history of diabetes have not been shown to be risk factors for RVO.
The study had a cross-sectional design, which could not determine causality, and used questionnaires to obtain medical histories, which are subject to bias.
Despite this, the researchers concluded that RVO is associated with older age and higher diastolic blood pressure, which could help identify those most at risk for RVO in the future.
The second poster2 focused on finding the best course of action for RVO management. Post-hoc analysis analyzed the impact of time on outcomes in macular edema following central VOR (MEfCRVO) and macular edema following branch VOR (MEfBRVO).
The study used data from 3 studies. COPERNICUS and GALILEO were randomized, multicenter, double-blind trials in treatment-naïve patients with MEfCRVO. These patients had a central subfield thickness (CST) greater than or equal to 250 mm and best corrected visual acuity (BCVA) from the ETDRS (Early Treatment Diabetic Retinopathy Study) of 20/40 to 20/320. VIBRANT was a randomized, multicenter, double-blind trial in treatment-naïve patients with MEfBRVO who had an ETDRS BCVA of 20/40 to 20/320.
In COPERNICUS, all patients received aflibercept intravitreal injection (IAI) 2 mg on a PRN basis from week 24 through week 100. In GALILEO, patients received IAI 2 mg as needed from week 24 through 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 grid laser of rescue 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.
Participants in the COPERNICUS and GALILEO studies were divided into 3 groups according to the time between diagnosis and treatment: less than 1 month, 1 to 3 months and more than 3 months. VIBRANT participants were divided into 2 groups: under 1 month and 1 month or older. The effect of baseline BCVA was assessed in 3 groups per study.
There were relatively more Hispanic patients in the COPERNICUS study who waited more than 3 months from diagnosis to treatment, but the number of Hispanic participants was low in all 3 groups. GALILEO and VIBRANT had similar demographics in all groups since diagnosis. Mean CST was lowest among those who waited more than 3 months between diagnosis and treatment in 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 treatment delay of more than 1 month.
A delay of more than 3 months before starting treatment was associated with less vision gain at week 24 compared to those receiving treatment within 1 month in the COPERNICUS and GALILEO studies. The mean CST decreased to a similar extent in all groups.
In the VIBRANT study, a delay of more than one month before starting treatment was associated with less vision gain at weeks 24 and 52 compared to people treated within one month of diagnosis. However, the mean CST decreased to the same extent in both diagnostic groups.
Patients with a lower baseline BCVA in both MEfCRVO and MEfBRVO had greater visual improvement, but had a lower average final BCVA than patients with better baseline BCVA.
The researchers concluded that these findings underscore the importance of prompt treatment for patients with MEfRVO and MEfCRVO.
1.Kalva P, Akram R, Zuberi H, Kooner K. The prevalence and risk factors for retinal vein occlusion (RVO) in the United States from the National Health and Nutrition Survey. Presented at: AAO 2022; September 30-October 3, 2022; Chicago, IL. Abbreviated PO426.
2. Sharma S. Impacts of time from diagnosis to baseline anti-VEGF and BCVA injection on retinal vein occlusion (RVO) outcomes. Presented at: AAO 2022; September 30-October 3, 2022; Chicago, IL. Summary PO394.