New research shows that treatment for retinal vein occlusion results in lasting vision gains, with visual acuity remaining significantly above baseline at five years. However, many patients require ongoing treatment. Retinal vein occlusion is one of the most common blinding conditions in the United States; Left untreated, central retinal vein occlusion (CRVO), the most serious type of retinal vein occlusion, often results in significant and permanent vision loss. A report on the five-year results of the Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) study was published April 21 in American Journal of Ophthalmology. SCORE2 was funded in part by the National Eye Institute (NEI), part of the National Institutes of Health.
Retinal vein occlusion is caused by blockage of the veins carrying blood away from the retina, the light-sensitive tissue at the back of the eye. This blockage can lead to macular edema where fluid becomes trapped in and under the retina, leading to rapid and severe loss of visual acuity. Without treatment, this condition usually results in permanent loss of vision. The most effective treatment, injections of anti-Vascular Endothelial Growth Factor (VEGF) drugs, helps control leaky blood vessels and retinal swelling.
“While anti-VEGF therapy is associated with significant improvement in both retinal swelling and visual acuity in patients with central or hemi-retinal vein occlusion, our results show that most patients followed still need treatment to control macular edema for at least five years,” said Ingrid U. Scott, MD, MPH, Penn State College of Medicine, Hershey, study chair. “This demonstrates the importance of continuous monitoring of these patients. »
In 2017, researchers from the SCORE2 clinical trial reported that two types of anti-VEGF treatment were equally effective in improving visual acuity in people with macular edema due to CRVO or eye occlusion. the hemi-retinal vein (HRVO). CRVO affects the entire retina, while HRVO usually affects about half of the retina. Half of the study participants had received Avastin (bevacizumab) while the other half received Eylea (aflibercept). Both drugs were given by injection once a month for six months. After six months, the vision of participants in both groups had, on average, improved over three lines on an eye chart.
As detailed in this new report, study researchers followed SCORE2 participants for five years, collecting information about their visual acuity, treatments and resolution of macular edema. After the initial 12-month study period, participants were treated at the discretion of their physician. Most physicians reduced the frequency of anti-VEGF injections and some switched their patients to the other anti-VEGF drug. At five years, many participants had lost some visual acuity compared to their acuity at 12 months; however, they retained an average of three lines of improvement, compared to their acuity at the start of the study.
“We were surprised to find that despite many participants still needing treatment after five years, their visual acuity remained very good,” said Michael Ip, MD, study co-chair of the Doheny Eye Institute. , University of California, Los Angeles. “Compared to this treatment for wet age-related macular degeneration, where initial vision improvements fade over time, these results are quite favorable. »
“This five-year study tells us a lot about what is happening with patients with retinal vein occlusion in the real world,” Scott said. “Before this study, retinal vein occlusion was widely considered an acute disease. This study shows that RVO is a chronic disease. She also emphasizes the importance of disease monitoring and individualized treatment to achieve the best vision possible. »
“The SCORE2 study provides invaluable data to guide clinicians and their patients toward informed decisions regarding the treatment of retinal vein occlusion,” said Michael F. Chiang, MD, Director of NEI.