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

Jeremiah Brown, MD

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.