Impact of race and socioeconomic disparities on the short-term efficacy of bevacizumab for macular edema secondary to retinal vein occlusion.

Objective: Anti-VEGF injections are often used for the treatment of macular edema from retinal vein occlusions (RVO). Variable response to intravitreal bevacizumab has been reported for treatment of diabetic macular edema (DME) between racial and ethnic groups. We examined potential variances in treatment response to bevacizumab by race and socioeconomic status among patients with macular edema secondary to RVO in this retrospective study.

Methods: Intravitreal anti-VEGF naïve patients aged over 18 who received at least one intravitreal bevacizumab injection for central or branch RVO were included. Data were collected before treatment, 1-3 months after the first injection (n = 150 eyes of 148 patients), and 1-3 months after 3 injections (n = 99 eyes of 98 patients). Primary outcome measures were percentage of patients with visual acuity (VA) improvement (defined as >0.1 on the logarithm of minimum angle of resolution scale), reduction in central macular thickness (CMT), and reduction in total macular volume (TMV). Participant addresses were used to calculate Area Deprivation Index (ADI) and were categorized into low disadvantage (state ADI decile from 1 to 5) or high disadvantage (state ADI decile from 6 to 10) cohorts. Odds of VA improvement were analyzed via multivariate logistic regression and mean change in CMT and TMV were analyzed via multivariate linear regression to compare treatment responses among the two ADI cohorts and between Black or African American and White participants after one and three injections.

Results: There were no significant differences in the odds of VA improvement (1-injection: OR=1.24, p = 0.60; 3-injection: OR=2.17, p = 0.23), percent reduction in CMT (1-injection: -31.2 vs -27.5, p = 0.98; 3-injection: -16.2 vs -32.7, p = 0.11), and percent reduction in TMV (1-injection: -15.5 vs -18.7, p = 0.44; 3-injection: -11.6 vs-15.4, p = 0.60) after controlling for demographic and clinical factors. There were no significant differences in the odds of VA improvement, percent reduction in CMT, and percent reduction in TMV between ADI cohorts (p > 0.05).

Conclusions: The absence of significant differences in treatment response amongst race groups is congruent with existing literature on RVO outcomes, however, it contrasts our findings in diabetic macular edema which did show differences in treatment response between race groups. There were also no significant differences in treatment by socioeconomic status.