The Burden of Retinal Venous Occlusion: An Assessment of Fellow Eyes in 1000 Cases

Abstract

To assess retinal vein occlusion (RVO) clinical features to create a simulation model quantifying the preference-based, patient value gain (benefit) and cost-utility (cost-effectiveness) of RVO therapy. Retrospective analysis data integrated with patient utilities and an ocular cost-utility model for RVO. One thousand consecutive Wills Eye Hospital Retina Service RVO patients seen from January 2010 through April2011. Value-Based Medicine analysis assessing the demographic features and vision in affected eyes and fellow eyes of RVO patients. Presenting vision, final vision, conversion incidence of fellow eyes to RVO, and patient value gain in quality-adjusted life-years (QALYs). Among 1000 patients, 332 (33.2%) presented with central retinal vein occlusion (CRVO), 53 (5.3%) with hemiretinal vein occlusion (HRVO), and 615 (61.5%) with branch retinal vein occlusion (BRVO). Mean follow-up for the entire RVO cohort was 3 years. One hundred and one patients (10.1%) had bilateral baseline RVO and, among the 826 unilateral cases seen more than once, 37 (4.5%) developed a fellow-eye RVO, a unilateral-to-bilateral conversion rate of 1.5%/year. Among the 101 baseline bilateral cases, 66% (66/101) had the same RVO variant bilaterally (CRVO/CRVO, HRVO/HRVO, or BRVO/BRVO). Mean CRVO baseline vision was 20/63-2 and final vision was 20/63-1 (P= 0.16). Thirty percent of patients had less than or equal to baseline fellow-eye vision. Within combined HRVO/BRVO cohorts, mean baseline vision was 20/50-2 and final vision was 20/50+1 (P= 0.0004). Thirty percent of patients also had less than or equal to baseline fellow-eye vision. The proportion of RVO patients with fellow-eye vision less than or equal to the RVO primary-eye baseline vision increased to 44% by year16. Thirty percent of all RVO patients had less than or equal to baseline vision in the fellow eye. Among unilateral RVO cases, 1.5%/year developed fellow-eye RVO. These findings have implications for cost-utility analysis, because bilateral vision loss yields greater QALY loss and an increased financial burden compared with unilateral loss. Referent to total therapeutic QALY gain (100%), if a treated RVO was always considered the better-seeing eye, the actual clinical scenario demonstrates that the average CRVO patient gains 38% as much value and the average HRVO/BRVO patient gains 37% as much.