The Injection Practice Patterns of Retina Specialists in Managing Exudative Age-Related Macular Degeneration: A Retrospective Study

Abstract

Purpose

To compare the PRN anti-VEGF injection patterns of four retina specialists with respect to the visual and anatomic outcomes in the management of wet age-related macular degeneration (AMD).

Methods

Medical records of patients who received bevacizumab, ranibizumab, and aflibercept anti-VEGF injections (years 2010–2020) by four retina specialists were reviewed for frequency, injection intervals, best corrected visual acuity (BCVA), and central macular thickness, center involved (CMT) for statistical analysis. Outcomes measured were change in logMAR BCVA and CMT from the first to last injection visit.

Results

Out of 137 AMD patients, 172 eyes were injected by four retina specialists in PRN fashion. Although all four specialists started the injection at similar baseline BCVA and CMT (p > 0.1), significant differences in mean injection number (9.0, p = 0.0001), injection intervals (5.06 weeks, p = 0.001), and total length of treatments (53.3 weeks, p = 0.0001) were observed. The mean change in logMAR BCVA between the first and last injection was −0.05, −0.22, 0.07, and 0.06 for the four specialists, respectively (p = 0.031), and the mean change in CMT was –53.3, −41.4, −72.7, and −21.9 µm (p = 0.41), respectively.

Conclusion

Despite similar baseline criteria for injections by the retina specialists, different anti-VEGF injection regimens were practiced resulting in variations in BCVA and CMT outcomes. This suggests a need in establishing a universally adoptable injection regimen with possible integration of the confounding factors to reduce burden on both patients and retina specialists.

Keywords:

• retina specialists
• practice patterns
• anti-VEGF
• central macular thickness
• best corrected visual acuity
• exudative age-related macular degeneration

Data Sharing Statement

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

Statement of Ethics

This study protocol was reviewed and approved by the UTMB Institutional Review Board (IRB), IRB #: 17-0065.

Consent to Participate Statement

Due to the retrospective nature of this study, exemption from requiring written informed consent was granted by the UTMB Institutional Review Board. All data collected were anonymized and de-identified to maintain confidentiality.

Acknowledgments

We express our sincerest gratitude to Efstathia Polychronopoulou for her invaluable contributions to the statistical analysis of our study. Cina Karimaghaei and Amir Ali are co-first authors for this study. This study was presented at the Association for Research in Vision and Ophthalmology Annual Meeting (May 3, 2021) and the 62nd Annual National Student Research Forum (May 15, 2021).

Author Contributions

All authors including Cina Karimaghaei, Amir Ali, Nida Safdar, Anika Tanwani, Mary Schmitz-Brown, Touka Banaee, Jaafar El-Annan, and Praveena Gupta made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors report no conflicts of interest in this work. The authors have no affiliation with the companies manufacturing the intravitreal agents used in this study.

Additional information

Funding

The research was supported by the Robertson-Poth Distinguished Chair in Ophthalmology Endowment Grant.