MedicalResearch.com Interview with:
Amy Babiuch, M.D.
Medical Retina Specialist | Cole Eye Institute
Assistant Professor Ophthalmology Case Western Reserve University
WPSA Regional Focus Committee Chair
MedicalResearch.com: What is the background for this study?
Response: In previous studies, the disorganization of retinal inner layers (DRIL) has demonstrated its ability to help determine visual acuity (VA) prognosis in diabetic macular edema that requires treatment. Given this association, the research group at Cole Eye Institute studied how DRIL may affect VA outcomes in patients with retinal vein occlusion (RVO) undergoing treatment for secondary macular edema.
DRIL is defined as the extent to which there is a failure in the recognition of any of the demarcations between the ganglion cell-inner plexiform layer complex, inner nuclear layer, and outer plexiform layer on optical coherence tomography (OCT).
MedicalResearch.com: What are the main findings?
DRIL in RVO study overview
We performed a retrospective study of 147 eyes from 147 patients with treatment naïve RVO and a minimum of 12 months follow-up. Seventy-five eyes had central retinal vein occlusion (CRVO) or hemi-retinal vein occlusion (HRVO), and 72 eyes had branch retinal vein occlusion (BRVO). Among the 147 patients, the mean patient age was 68.9 years, 75 (51 percent) were female and 72 (49 percent) were male. Baseline DRIL was identified in 61.9 percent of all eyes (91/147).
DRIL scoring on OCT
We used a presence or absence approach to score DRIL across three regions on the horizontal OCT line scan at baseline, six months, and 12 months. The horizontal line scan was broken down into 3 regions representing the central 1mm, central 2mm excluding the central 1mm, and the region outside the central 2mm. At six and 12 months, DRIL scores were further evaluated for stable, increasing or decreasing DRIL burden.
At six months, DRIL scores in all regions demonstrated a decrease in detection, however, at 12 months, all regions revealed a modest increase in DRIL detection.
When we compared this to the number of anti-VEGF injections delivered, we found that the average number of injections decreased by about half in months six to 12 as compared to the first six months in both groups. This decline in treatment with anti-VEGF agents may have allowed for progression of disease and worsening DRIL scores in months six to 12.
MedicalResearch.com: What should readers take away from your report?
DRIL and visual acuity outcomes
Based on the results of our study, we concluded that the presence of DRIL at baseline in BRVO patients is associated with worse baseline VA. Increasing DRIL burden in CRVO and HRVO patients is associated with reduced VA gains.
DRIL in RVO study conclusions
Baseline DRIL presence and changes in DRIL burden during the course of disease in RVO is a useful prognostic indicator for VA and can help guide treatment with anti-VEGF therapy.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Manual detection and measurement of DRIL can be difficult, therefore, automation of DRIL measurement by OCT software may prove useful in future treatment paradigms as well as VA prognostication.
Association of findings on OCT angiography in areas of DRIL on SDOCT could further improve our understanding of the pathophysiology of DRIL and its relationship to VA.
Disclosures: Disclosures within the last 12-months include honoraria from VINDICO and MCME Global.
Babiuch AS, Han M, Conti FF, Wai K, Silva FQ, Singh RP. Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion. JAMA Ophthalmol. Published online October 04, 2018. doi:10.1001/jamaophthalmol.2018.4484
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