Skip to main content

  • Real-World Assessment of BRVO Treatment

    By Jean Shaw
    Selected By: Prem S. Subramanian, MD, PhD
    Add to My Bookmarks

    Journal Highlights

    British Journal of Ophthalmology
    Published online June 12, 2020

    Download PDF

    Evidence from clinical trials suggests that anti-VEGF drugs are more effective than dexamethasone implants for the treatment of macular edema secondary to branch retinal vein oc­clusion (BRVO). However, it can be difficult to translate clinical trial results to daily practice. Therefore, Gale et al. set out to evaluate this conclusion in a real-world setting with data from a large and diverse population, and they included macular laser outcomes for additional comparison. They found that visual acuity (VA) improved more with anti-VEGF treatment than with the oth­er strategies. In addition, although an­ti-VEGF injections conferred a higher treatment burden, some of the impact of that burden decreased over time.

    For this study, the researchers used data collected at 27 U.K. National Health Service centers between Feb­ruary 2002 and September 2017 from patients who received treatment for BRVO. Of an initial dataset of 19,141 eyes, 5,251 met the inclusion criteria of being treatment-naive at the start of therapy and having both baseline and follow-up VA measurements. The mean age of the study population was 72.1 years, and 52.6% were female. Out­comes of interest were changes in VA and mean number of treatments over a 36-month period.

    Mean baseline VA was 57.1 ETDRS letters in those treated with anti-VEGF injections (n = 3,939), 53.1 in those who received the dexamethasone implant (n = 676), and 62.3 for those treated with laser (n = 636). Following treatment, VA changed as follows:

    • At 12 months, mean VA was 66.72 letters in the anti-VEGF group, 57.6 in the dexamethasone group, and 63.2 in the laser group.
    • At 18 months, mean VA was 66.6, 56.1, and 60.8 letters, respectively.
    • Only the anti-VEGF group had ade­quate 36-month data; mean VA in this group at that point was 68 letters. 

    With regard to treatment burden, the anti-VEGF group received a mean of 5.1 treatments during the first 12 months, while the dexamethasone and laser groups received 1.5 and 1.2, re­spectively. During the first 18 months, the mean number of treatments were 5.9, 1.7, and 1.2, respectively. Again, 36-month data were available for only those in the anti-VEGF group, who received a mean of 6.9 treatments during this time period. The authors suggest that, despite the treatment bur­den, visual outcomes were better with anti-VEGF therapy.

    The original article can be found here.