Treatment of retinal vein occlusion results in long-term improvement in vision, though many patients need continuous anti-vascular endothelial growth factor (VEGF), according to a report on the five-year outcomes of the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) published in the American Journal of Ophthalmology.^1,2

In this multicenter study, researchers from the United States set out to examine the results of aflibercept or bevacizumab treatment for macular edema because of central retinal vein occlusion or hemiretinal vein occlusion at five years among participants of SCORE2 study. Visual acuity letter score (VALS) and central subfield thickness (CST) on optical coherence tomography were selected as the main outcome measures. Patients were treated for 12-months as per protocol and were then followed up to 60 months during which period they were treated as per decision of their physicians. Patients received anti-VEGF injections less frequently, while some patients were shifted to an anti-VEGF drug other than the two drugs under study.

Seventy-five percent participants logged in at least one visit between Months 24 and 60, while 45% completed the Month 60 visit. Among the study subjects who completed the Month 60 visit, the overall improvement in VALS was 13.5 (mean), but this improvement was less than that observed at 12 months, when it was 20.6. The baseline CST was 671 microns and at Month 60, it was 261 microns.

Central retinal vein occlusion is a severe blinding condition and usually has a poor prognosis. The loss of vision is considerable and also permanent. Intravitreal injections of anti-VEGF drugs to reduce swelling and neovascularization are the most effective treatment options.

The six-month results of the SCORE2 trial were published in JAMA in 2017, which had shown comparable beneficial effects of both intravitreal bevacizumab and aflibercept on visual acuity.³

This study, supported by the National Institutes of Health (NIH) demonstrates marked improvement in visual acuity when anti-VEGF was administered as per protocol at 12 months. However, the visual acuity declined somewhat at Month 60 when treatment was at the discretion of the physician, note the authors, though it continued to show improvement (on average three lines of improvement on an eye chart) over baseline. Most patients continued to receive treatment at Month 60 to control the macular edema signifying the need for continued monitoring of such patients and institution of anti-VEGF therapy, as needed in the individual patient, to achieve the best vision. “Prior to this study, retinal vein occlusion was widely considered an acute illness. This study shows that RVO is a chronic disease,” said Ingrid U Scott from Penn State College of Medicine, Hershey and chair of the study.

References

1. Scott IU, et al;SCORE2 Investigator Group. Month 60 outcomes after treatment initiation with anti-VEGF therapy for macular edema due to central or hemi-retinal vein occlusion. Am J Ophthalmol. 2022 Apr 21: https://doi.org/10.1016/j.ajo.2022.04.001.
2. NIH press release, April 21, 2022. https://www.nih.gov/news-events/news-releases/vision-improvement-long-lasting-treatment-blinding-blood-vessel-condition.
3. Scott IU, et al. Effect of bevacizumab vs aflibercept on visual acuity among patients with macular edema due to central retinal vein occlusion: The SCORE2 Randomized Clinical Trial. JAMA. 2017 May 23;317(20):2072-2087. doi: 10.1001/jama.2017.4568.