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

Abstract

Cina Karimaghaei,1,2,* Amir Ali,3,* Nida Safdar,4,5 Anika Tanwani,3 Mary Schmitz-Brown,2 Touka Banaee,2 Jaafar El-Annan,2 Praveena K Gupta2 1Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA; 2Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA; 3School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; 4Department of Ophthalmology, Nazareth Hospital, Trinity Health Mid-Atlantic, Philadelphia, PA, USA; 5IC Laser Eye Care, Bensalem, PA, USA*These authors contributed equally to this workCorrespondence: Praveena K Gupta Professor, Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA, Tel [phone], Fax [phone], Email [email protected]: 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

Keywords

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