Retina specialists choose treatment vs observation for macular edema due to RVO
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Retina specialists more aggressively treat macular edema due to retinal vein occlusion than do other physicians, according to Vrinda S. Hershberger, MD, PhD.
A real-world study using data from a medical claims database showed the most common treatment after diagnosis of macular edema due to retinal vein occlusion (RVO) was observation. In contrast, a survey of retina specialists found they treated the majority of patients with anti-VEGF injections within 2 weeks of diagnosis.
“Based on the differences in treatment patterns ... we hypothesized that some RVO patients with macular edema may not be referred to retina specialists until advanced vision-threatening stage,” Hershberger said at the virtual American Society of Retina Specialists meeting.
Hershberger and colleagues compared real-world treatment for macular edema due to RVO based on U.S. claims data from the Truven MarketScan database and a direct survey of 35 retina specialty sites across the country.
The RVO medical claims database analysis included retinal vein occlusion patients with macular edema who were 18 years or older with a diagnosis of macular edema secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). The 35 retina specialty sites were surveyed regarding their treatment patterns for macular edema due to RVO.
According to the MarketScan claims data, approximately 40% of patients received no treatment for RVO within the first year of diagnosis. The most common treatment, if one was chosen, was anti-VEGF injection alone, with 38% of BRVO with macular edema patients and 45% of CRVO with macular edema patients treated with injections. Less than 15% of patients received combination therapy and less than 4% received either laser or corticosteroid monotherapy, Hershberger said.
Among patients treated with anti-VEGF injections in the claims database, approximately half received five or fewer anti-VEGF injections and only 10% received 10 or more injections within the first year of diagnosis.
All 35 surveyed retina specialists reported treating patients with anti-VEGF therapy, with approximately 80% reporting treatment within 2 weeks of the first visit. The most commonly reported regimen for BRVO and CRVO was monthly injections. Pro re nata and treat-and-extend regimens were less common, Hershberger said.
Additionally, 56% and 72% of retina specialists reported treating patients for more than 2 years for BRVO and CRVO, respectively, with 19% reporting a 1- to 2-year treatment duration for both BRVO and CRVO, she said.
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Hershberger VS, et al. Real-world treatment patterns in patients with macular edema due to retinal vein occlusion. Presented at: American Society of Retina Specialists annual meeting; July 24, 2020 (virtual meeting).
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