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  • SCORE2 Report: VA, CST Outcomes, and Treatment Adherence

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, April 2023

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    Six-month results from the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) showed that improvement in the VA letter score was comparable for bevacizumab and aflibercept for treatment of macular edema (ME) and retinal vein occlusion. After month 12, improvements dimin­ished when the SCORE2 protocol was replaced with treatment at the investiga­tor’s discretion. Although most patients continued anti-VEGF treatment during follow-up, one-third received no treat­ment in year 5.

    In a subsequent study, Scott et al. sought to characterize the profile of patients who stopped treatment and determine whether outcomes for VA letter score and central subfield thick­ness (CST) played a role in the decision to halt or continue treatment. They found that patients who discontinued early were younger at baseline and more likely to be Black than were those who received uninterrupted treatment. Although the VA letter score generally did not differ between these groups over time, those who stopped treatment had a significantly lower mean CST and a higher proportion of complete ME resolution by month 60.

    The investigators classified those who completed 60 months of participa­tion in SCORE2 (N = 150) into one of three groups: early discontinuation of treatment (n = 23), intermittent treat­ment (n = 41), and continuous treatment (n = 86). Mean age at baseline was 60.9, 66.7, and 70.5 years, respec­tively, among the three groups.

    There was little difference among the groups in VA or change in VA over time. The early-discontinuation group had a larger percentage of resolved ME relative to the other groups (69.6% vs. 15% or 15.7%; p < .001). Moreover, those who stopped treatment had lower mean CST during follow-up (257 μm) than did those treated continuously (300 μm; p = .01) or intermittently (303 μm; p = .02). Blacks represented 17.4% of participants who discontin­ued treatment, 19.5% of patients treat­ed intermittently, and 4.7% of those treated continuously.

    The authors emphasized that these findings support the need for ongoing monitoring and personalization of anti-VEGF treatment for patients with ME caused by retinal vein occlusion.

    The original article can be found here.