Disparities in Retinal Vein Occlusion Presentation and Initiation of Anti-VEGF Therapy: an Academy IRIS® Registry Analysis

OBJECTIVE:Investigate disparities in retinal vein occlusion (RVO) presentation and initiation of anti-vascular endothelial growth factor (anti-VEGF) treatment. DESIGN:Retrospective cohort study SUBJECTS: Patients in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) database (2015-2021) with branch or central retinal vein occlusion and macular edema (ME) METHODS: The association of demographic characteristics and presenting visual acuity with anti- VEGF treatment initiation were quantified using multivariable logistic regression. MAIN OUTCOME MEASURES:Treatment with ≥1 anti-VEGF injection within 12 months after RVO diagnosis. RESULTS:304,558 eligible patients with RVO and ME were identified. Age at presentation varied by race, ethnicity, sex and RVO type (all p values <0.001). Within the first year after RVO presentation, 192,602 (63.2%) patients received ≥1 anti-VEGF injection. In a multivariable regression model adjusting for relevant covariates, female (vs. male) patients had lower odds of receiving injections (odds ratio (OR) [95% confidence interval (CI)]: 0.95 [0.93,0.96], p < 0.0001) as did Black/African American (vs. White) patients (OR: 0.90 [0.88,0.92], p < 0.0001) and Asian (vs. White) patients (OR:0.95 [0.91, 0.99], p=0.02) while older patients (vs. patients < 51 years old) had higher odds (61-70 years: OR: 1.20 [1.16,1.24]; 71-80 years: OR: 1.20 [1.16,1.24]; >80 years: OR: 1.15 [1.11,1.18]; all p values < 0.0001). Hispanic (vs. non-Hispanic) patients had a small increased odds of treatment initiation (OR:1.08 [1.04,1.11], p < 0.0001). Results were similar in the subset of 226,143 patients with visual acuity (VA) data. In this subset, patients with presenting VA <20/40 - 20/200 were most frequently treated in the first year after diagnosis (∼70%) and patients with light perception-no light perception (LP-NLP) vision or VA of 20/20 or better were treated least frequently (36.9% and 41.9%, respectively). CONCLUSIONS:In this large national clinical registry, 37% of RVO patients with macular edema had no anti-VEGF treatment documented in the first year after diagnosis. Black/African American, Asian, and female patients and patients with VA of LP-NLP were least likely to receive treatment. Awareness of this undertreatment and these disparities highlight the need for initiatives to ensure all RVO patients receive timely anti-VEGF injections for optimized visual outcomes.