Predictors of response to a lapse in anti-VEGF treatment in patients with macular edema secondary to retinal vein occlusion

Christopher M Maatouk; Jessica C Liu; Peter Alsaloum; Amogh I Iyer; Peter M Kaiser; Rishi P Singh; Katherine E Talcott

doi:10.1016/j.jcjo.2023.08.002

Predictors of response to a lapse in anti-VEGF treatment in patients with macular edema secondary to retinal vein occlusion

Can J Ophthalmol. 2023 Sep 14:S0008-4182(23)00250-8. doi: 10.1016/j.jcjo.2023.08.002. Online ahead of print.

Authors

Christopher M Maatouk¹, Jessica C Liu², Peter Alsaloum², Amogh I Iyer³, Peter M Kaiser⁴, Rishi P Singh⁵, Katherine E Talcott⁶

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio.
² Case Western Reserve University School of Medicine, Cleveland, Ohio.
³ Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio; The Ohio State University College of Medicine, Columbus, Ohio.
⁴ Cleveland Clinic Martin Health, Stuart, Fla.
⁵ Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio; Cleveland Clinic Martin Health, Stuart, Fla.
⁶ Center for Ophthalmic Bioinformatics, Cleveland Clinic, Foundation, Cleveland, Ohio; Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: ktalcott@gmail.org.

PMID: 37716706
DOI: 10.1016/j.jcjo.2023.08.002

Abstract

Background: Macular edema (ME) in the setting of retinal vein occlusions (RVO) is a common cause of vision loss worldwide. Anti-vascular endothelial growth factor (anti-VEGF) injections are the gold standard for ME secondary to RVO. Despite their efficacy, anti-VEGF injections carry significant burdens for patients, resulting in high rates of loss to follow-up and treatment lapses.

Methods: A sub-analysis examining the effects of a treatment lapse in RVO patients was conducted. Sixty patients were included and separated into vision-loss and stable-vision groups based on change in vision after a lapse. A logistic regression with age, body mass index (BMI), history of dyslipidemia, and time since diagnosis of RVO as predictors was used to predict whether patients would experience vision loss after a lapse.

Results: The average lapse was 5.6 months and similar in the vision-loss and stable-vision groups. At baseline, the vision-loss group was older and had a lower BMI (p < 0.05). Age and history of dyslipidemia increased the odds of vision loss by factors of 1.23 (range, 1.10-1.45) and 8.40 (range, 1.62-66.2), respectively. BMI and time since RVO diagnosis decreased the odds of vision loss by factors of 0.83 (range, 0.69-0.95) and 0.95 (range, 0.90-0.99), respectively. The final model had a specificity of 87.5% and a sensitivity of 70.0%.

Conclusions: Patients' responses to treatment lapses for ME secondary to RVO can be predicted with reasonable accuracy using readily available clinical data, particularly age, BMI, time since diagnosis, and history of dyslipidemia. Providers should consider these factors when counselling patients and determining follow-up schedules.