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Two-Year Outcomes Comparing Anti-VEGF Injections to Laser for ROP Using a Commercial Claims Database
Insights
Infants treated for retinopathy of prematurity (ROP) with anti-vascular endothelial growth factor (VEGF) injections showed similar ocular and neurodevelopmental outcomes compared to laser treatment. Retinal detachment rates were comparable between the two ROP treatment methods.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Health Services Research
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Treatment options for ROP include laser photocoagulation and anti-vascular endothelial growth factor (VEGF) injections.
- Comparative outcomes of these treatments, particularly neurodevelopmental aspects, require further investigation.
Purpose of the Study:
- To compare ocular and neurodevelopmental outcomes in infants treated for ROP using anti-VEGF injections versus laser therapy.
- To analyze data from a nationwide health insurance claims database for treatment outcomes.
Main Methods:
- Retrospective cohort study utilizing the MarketScan database (2011-2017).
- Identified 298 infants treated for ROP with either laser or anti-VEGF injections.
- Followed patients for 2 years to assess ocular and neurodevelopmental outcomes via claims data.
Main Results:
- The anti-VEGF group had higher rates of underlying neurological comorbidities and thrombocytopenia.
- Ocular outcomes, including retinal detachment, were similar between the anti-VEGF and laser groups.
- While second procedures were more common after anti-VEGF injections, language, motor, and cognitive delays were comparable. Cerebral palsy rates were not statistically significant after adjustment.
Conclusions:
- Anti-VEGF treatment for ROP demonstrated similar long-term ocular outcomes, such as retinal detachment, compared to laser treatment.
- Neurodevelopmental outcomes, including language, motor, and cognitive delays, were not significantly different between the treatment groups, even with higher baseline comorbidities in the anti-VEGF group.
Background And Objective:
To report ocular and neurodevelopmental outcomes among infants treated for retinopathy of prematurity (ROP) in a nationwide health insurance claims database.
Patients And Methods:
Retrospective cohort study of 298 infants treated with laser or anti-vascular endothelial growth factor (VEGF) injection identified in the MarketScan database (2011-2017) with 2-year follow-up.
Results:
A review of claims data found 298 patients with International Classification of Diseases and Common Procedural Technology codes for ROP treatment and 2 years of continuous insurance coverage. Of these, 63 infants received injections and 235 received laser. Overall, the anti-VEGF group had higher rates of underlying neurological comorbidities (35% vs. 23%; P = .05) and thrombocytopenia (17% vs. 8%; P = .02). Most ocular outcomes were similar, including retinal detachment (P = .87). There were higher rates of second procedures after injection (44% vs. 10%; P < .001). Rates of language, motor, and cognitive delays were similar. Rates of cerebral palsy were higher with injections but were not statistically significant after adjusting for comorbidities (odds ratio = 1.88; P = .10).
Conclusions:
The prevalence of retinal detachment after 2 years was similar comparing anti-VEGF to laser. Despite the higher rates of underlying neurologic comorbidity in the injection group, there were no differences in language, motor, or cognitive delays. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:486-493.].
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