Profile of Patients Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections in Bhutan

Abstract

Purpose

Ocular vascular diseases are common causes of visual impairment and blindness, for which anti-vascular endothelial growth factor (anti-VEGF) is the first-line therapy. Current study describes the profile of patients receiving intravitreal anti-VEGF injections (IVI), and gender variation in Bhutan. The study was designed to inform national health policy.

Study Design

Retrospective cross-sectional study.

Methods

We reviewed the surgical registers of the vitreoretinal (VR) units across Bhutan over three years. Patient demography, clinical findings, diagnostic tests performed, and diagnoses or indications for IVI were logged. A descriptive analysis was performed.

Results

Despite limited availability of anti-VEGF, a total of 381 patients received IVI in operating theatres as mandated by the national guidelines. The majority of patients were males (230, 60.4%, p = 0.004). The mean age was 65.2 ± 13.5 years (range 13 years to 90 years), and a median of 69 years. The majority of the treated eyes (117, 30.7%) had BCVA <3/60 to light perception (PL), and another 51 eyes (13.4%) had < 6/60 to 3/60. The most common indication for IVI was neovascular age-related macular degeneration (nAMD) (168 cases, 42.2%), followed by retinal vein occlusion (RVO) (132 cases, 34.6%), diabetic macular oedema (DMO) and retinopathy (DR) (50 cases, 13.1%), and myopic choroidal neovascular membrane (11 cases, 0.03%).

Conclusion

Limited human resources for managing VR diseases in Bhutan are compounded by economic and geographic challenges. With increasing VR diseases such as nAMD and myopia and complications of systemic diseases such as DR, DMO and RVO, there is a need to improve VR services. Currently, anti-VEGF is procured only for a pooled patients requiring IVI, and patients are lost due to longer waiting periods. Bhutan needs to assess if females are reporting less or are not receiving treatment due to cultural barriers and social stigma.

Keywords:

• anti-VEGF
• Bhutan retinal diseases
• diabetic macular oedema
• intravitreal injection
• neovascular AMD
• retinal vein occlusion

Data Sharing Statement

The data and material are available from the corresponding author.

Ethical Approval, Informed Consent and Consent for Publication

The study was approved by the Research Ethics Board of Health (REBH) (REBH/Approval/2016/083), Ministry of Health, Royal Government of Bhutan, and was conducted as per the REBH guidelines and tenets of the Declaration of Helsinki. The consent was waived by REBH as the retrospective study collected only the de-identified data.

Disclosure

BBR reports a scholarship provided by the Australian National University that supported the study. TM report grants from the MRFF Biotechnology Bridge (BTB) Program – research grant number: BTBR100196, during the conduct of the study; and grants from Konan Medical USA, outside the submitted work. In addition, he has a patent application (P0040304AU) on novel analysis methods for mfPOP/OFA pending to Konan Medical USA. He owns shares from EyeCo Pty Ltd. The authors report no other conflicts of interest in this work.

Additional information

Funding

This is an Australian Government funding agency awarded to the Australian National University. This agency supplied 50% of the funding for this grant. As required by the grant the other 50% was matched funding 25% from our university (the Australian National University) and 25% from a potential commercial partner, which for this grant was Konan Medical USA.