Anti-VEGF Use in Retinal Vein Occlusion: Insights from a Real-World Cohort

Despite widespread adoption of anti-vascular endothelial growth factor (VEGF) therapy for retinal vein occlusion (RVO)-associated macular edema, questions remain about how long visual gains persist and what level of treatment is required to maintain them.

To address this question, a study published in Ophthalmology Retina in May 2025 presents five-year real-world data on the use of anti-VEGF therapy for macular edema secondary to retinal vein occlusion.

Here’s a brief overview of the study and what it found.

A Large-Scale Retrospective Analysis
Using the Vestrum Health Retina database, researchers retrospectively analyzed 22,365 eyes with branch RVO (BRVO) and 18,064 with central RVO (CRVO), all of which were treatment-naïve and received at least one intravitreal anti-VEGF injection between 2014 and 2021.

Early Gains, Gradual Decline
Initial visual acuity (VA) gains were observed following treatment. At 12 months, BRVO eyes gained an average of 11.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and CRVO eyes gained 9.7 letters.

These gains declined by month 60 to 8.2 letters for BRVO and 5.3 for CRVO.

Improvements were most pronounced in the first three months, when both groups gained approximately 11 letters from baseline.

Injection Frequency Over Time
Treatment frequency was highest early in the course of care. In year one, eyes received an average of 6.9 (BRVO) and 7.0 (CRVO) anti-VEGF injections. By year five, this decreased to 3.7 and 3.9, respectively.

Still, among eyes that remained in follow-up through year five, a majority continued to receive treatment: 68 percent in BRVO and 71 percent in CRVO.

Dose-Response Relationship
A stratified analysis showed that visual outcomes varied by injection frequency. In BRVO, mean VA gain at 60 months was 6.3 letters in the lowest injection tertile and 10.8 letters in the highest. In CRVO, the difference was more marked: −0.6 versus 9.1 letters.

Similarly, eyes with higher injection ratios, defined as the proportion of visits involving anti-VEGF injections, had significantly better VA outcomes at 18 months. In CRVO, the highest ratio group gained 7.2 more letters than the lowest group (P < 0.0001); BRVO showed a 4.6-letter difference (P < 0.0001).

Adjunctive Therapy Trends
Adjunctive therapies were uncommon early on but became more prevalent with longer follow-up. By month 60, focal/grid-pattern laser had been used in 24 percent of BRVO eyes and 5 percent of CRVO eyes. Intravitreal corticosteroid use reached 14 percent in both groups.

These treatments were generally not part of initial management but appeared more frequently later in the disease course.

Study Limitations
The authors note several factors that may influence interpretation.

As with other retrospective analyses, selection bias, loss to follow-up, and missing data are potential limitations. The absence of specific coding for hemiretinal RVO and lack of imaging data may also constrain diagnostic precision. Eyes with better early outcomes may have exited follow-up earlier, while those with poorer vision or persistent disease may have remained longer under observation, potentially influencing long-term VA trends.

Clinical Implications
Nevertheless, the dataset provides a large-scale perspective on RVO management in clinical practice. The findings indicate that while anti-VEGF therapy was associated with early visual acuity (VA) gains, both treatment frequency and VA outcomes declined over time. Longer-term follow-up was linked to increased use of adjunctive therapies.

Importantly, eyes receiving more injections achieved better outcomes, whereas those with longer follow-up tended to have lower gains, highlighting the complex relationship between treatment frequency and vision maintenance.

These trends suggest that macular edema secondary to RVO often requires sustained treatment and continued long-term monitoring.

Reference:
Ip M, Modi Y, Fekrat S, et al. Treatment Patterns and Long-term Outcomes with AntieVEGF Therapy for Retinal Vein Occlusion. Ophthalmol Retina. Published online May 27, 2025.