New Study Examines Role of Anti-VEGF Injections on Treatment Patterns

In new data presented at the American College of Ophthalmology (AAO) 2020 Virtual Conference, investigators examined new treatment patterns for patients with diabetic retinopathy.

A team led by Jeremiah Brown, MD, investigated the use of anti-vascular endothelial growth factor (anti-VEGF) treatments in patients with proliferative diabetic retinopathy using the AAO Intelligent Research in Sight (IRIS) Registry.

In the study, the investigators examined 33,452 patients with a diagnosis of PDR and a new diagnosis of vitreous hemorrhage between June 2017 and June 2018 that received treatment within 3 months. The researchers calculated the rate of usage of anti-VEGF medications, panretinal photocoagulation (PRP), and vitrectomy surgery and compared visual acuity results at 6 months.

The investigators found 22,484 (83.6%) patients who had PDR and diabetic macular edema (DME) that were treated with anti-VEGF medication. In addition, they found 4511 (68.7%) patients without DME that were treated.

PRP alone was performed in 8320 (31%) patients without DME and 2317 (35%) of patients without DME, while 7246 (22%) patients had vitrectomy surgery.

In addition, anti-VEGF treatment was used in 49.1% (n = 3571) of patients receiving vitrectomy and visual acuity results were similar in patients regardless of anti-VEGF use.

Overall, very little difference was found in visual acuity whether or not anti-VEGF medications were used.

“Treatment patterns for patients with PDR have changed significantly, with a prominent role for anti-VEGF therapy,” the authors wrote. “Visual acuity results were similar with and without anti-VEGF therapy.”

In recent years, anti-VEGF medications have greatly improved treatment for diabetic retinopathy, with clear indications of diabetic macular edema. However, the timing and need for anti-VEGF medications in treating proliferative diabetic retinopathy is not entirely known.

In a separate study presented at AAO 2020, investigators found anti-VEGF treatments have an impact on another of other outcomes.

A team, led by Sahar Bredrood, MD, PhD, Acuity Eye Group & Retina Institute - Pasadena, examined the impact of anti-VEGF injections on the prevalence of ocular hypertension (OHT) and primary open-angle glaucoma (POAG) with age-matched controls.

In the 1 year, case control study, the investigators examined 927 eyes coming from 624 consecutive patients.

Each patient received an intravitreal injection (IVIs) of an anti-VEGF agents involving bevacizumab, ranibizumab or a combination for either neovascular age-related macular degeneration (AMD) or diabetic macular edema.

The investigators found the treatment arm of the study had a significant increase in OHT, POAG, and glaucoma suspect (GS) when compared to the healthy control group (P < 0.00001, P < 0.0001 and P < 0.05, respectively).

Within the glaucoma suspect portion of the trial, the investigators found 18% of patients had cupping and retinal nerve fiber layer loss without ocular hypertension. POAG and OHT were also positively linked with the number of intravitreal injections (R² = .856, P = .008, and R² = .749, P < .05, respectively).

The study, “Current U.S. Patterns for the Treatment of PDR in the IRIS Registry,” was published online by AAO 2020.