title: Treatment Patterns for Myopic Choroidal Neovascularization in the United States: Analysis of the IRIS Registry.
abstract: To characterize treatment patterns and outcomes in eyes with treatment-naïve myopic choroidal neovascularization (mCNV) in the United States.
  
  
  
  Retrospective cohort study.
  
  
  
  Individuals aged 18 years and older seen in clinics participating in the American Academy of Ophthalmology's IRIS (Intelligent Research in Sight) Registry.
  
  
  
  We analyzed data from the IRIS Registry, from January 1, 2012 to December 31, 2014, to identify cases of treatment-naïve mCNV, which was defined as the presence of myopic refractive error worse than -6.0 diopters with the presence of subretinal/choroidal neovascularization as indicated by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of "362.16: Retinal Neovascularization NOS."
  
  
  
  Type of initial treatment for mCNV was categorized as the administration of 1 of the following within the first 365 days after the diagnosis date: (1) observation (i.e., no treatment); (2) intravitreal anti-VEGF injection; (3) verteporfin photodynamic therapy (vPDT); or (4) laser photocoagulation. We assessed the difference between logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) on the diagnosis date (baseline) and 1 year after the diagnosis date. Anti-VEGF injection frequency per treated eye over a 1-year period was also estimated.
  
  
  
  We identified 185 patients with treatment-naïve mCNV in 1 or both eyes. Treatment within 1 year of diagnosis was recorded for 73.0% (135/185); the remainder was classified as "observation." Nearly all treatment (134/135; 99.3%) consisted of anti-VEGF injections; 0.7% (1/135) received vPDT. Those treated with anti-VEGF injections showed significant improvement in VA at 1 year (mean logMAR VA improvement of 0.17 units, 95% confidence interval [CI], 0.12-0.20, P < 0.01), whereas those who were not treated showed a significant decline in VA at 1 year (mean logMAR VA decline: 0.03 units, 95% CI, 0.008-0.05, P < 0.01). The mean number of anti-VEGF injections for an eye with mCNV during the first year after diagnosis was 2.8 (standard deviation, 2.5) (median, 2.0; interquartile range, 1.0-4.0).
  
  
  
  In the United States, anti-VEGF injection was the most frequently utilized treatment for mCNV. Those treated were observed to gain vision. However, one quarter of patients received no treatment and lost vision. Further studies are needed to understand the sociodemographic and health-systems barriers surrounding the delivery of anti-VEGF injections to patients with mCNV.
authors.affiliation: Department of Ophthalmology, UC Davis Medical Center, Sacramento, California; Genentech, Inc, South San Francisco, California.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Willis
authors.affiliation: Department of Ophthalmology, UC Davis Medical Center, Sacramento, California.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Morse
authors.affiliation: Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Vitale
authors.affiliation: American Academy of Ophthalmology, San Francisco, California.
authors.forename: David W
authors.initials: DW
authors.lastname: Parke
authors.affiliation: American Academy of Ophthalmology, San Francisco, California.
authors.forename: William L
authors.initials: WL
authors.lastname: Rich
authors.affiliation: American Academy of Ophthalmology, San Francisco, California. Electronic address: flum@aao.org.
authors.forename: Flora
authors.initials: F
authors.lastname: Lum
authors.affiliation: Genentech, Inc, South San Francisco, California.
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Cantrell
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D020256:Choroidal Neovascularization / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011166:Porphyrins / Q000627:therapeutic use*; D000069579:Ranibizumab / Q000008:administration & dosage*; D012029:Refraction, Ocular; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D000077362:Verteporfin; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D017319:Photosensitizing Agents; D011166:Porphyrins; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; D000068258:Bevacizumab; D000069579:Ranibizumab