Study Shows Increase in Use of Anti-VEGF Injections

HOT TOPIC

Anti-VEGF Injection Use on the Rise

A recent study characterizing trends in the use of and Medicare expenditure associated with intravitreal injections of anti-VEGF agents aflibercept (Eylea, Regeneron), bevacizumab (Avastin, Genentech), and ranibizumab (Lucentis, Genentech) from 2014 to 2019 shows a dramatic increase. The annual Medicare expense for these injections topped $4 billion in 2019 compared with $2.51 billion in 2014.

The study’s collected data consist of 17,588,995 intravitreal injection claims filed by 4,218 US ophthalmologists. The study authors found that more local ophthalmologists performing the injections and the incremental increases in the average reimbursement amounts were “significantly associated with a 6.8-fold variation in 2019 overall anti-VEGF injection rates across states.” They also discovered that the population-adjusted aflibercept injection rate increased 138% from 2014 to 2019, while the others (ranibizumab and bevacizumab) stayed relatively flat. According to the authors, the uptick in aflibercept use may be due to “… aflibercept … approved for wet AMD, expanding indications in the management of ophthalmic disease.” Additionally, they noted that the ability to extend patients for a longer period of time between injections could also potentially explain the increase in aflibercept injection rates.

My Two Cents

Although this study profiles old data (2014-2019), the message is loud and clear: anti-VEGF therapy is a huge expense in government health care. There’s no arguing that this expense has grown exponentially since 2019, and I’m hopeful that more recent data will be released. To put that $4 billion into perspective, the entire US contact lens market was $14.55 billion last year. These aren’t small numbers we’re talking about, and it’s yet another arrow in the quiver that organized optometry can use to show that our large numbers and workforce could potentially help alleviate some of these astronomic causes by allowing us to handle some of these injections. I have numerous friends who are retina specialists, and they would much rather be in the OR than giving dozens of injections each day. Let’s use these data to our advantage in our continued fight for better patient access and care!

OUTSIDE THE LANE

Study Determines Most Significant Unmet Refractive Need in US

Another new study, published in JAMA Ophthalmology, revealed that the most significant unmet refractive need in our country is found in the Black population. Research from the Southern California Eye Institute assessed the prevalence of uncorrected refractive error in 6,337 participants of its population-based study of eye disease in Black adults 40 years and older residing in Los Angeles. Correctable refractive error was found to be the leading cause of visual impairment. Because lower income was most strongly correlated with a higher likelihood of uncorrected refractive error in the Black population, the authors of the study argue that universal vision coverage is an unmet need in the United States.

The study researchers defined individuals with unmet refractive needs as those whose presenting VA was worse than 20/40. This refractive error-related (correctable) impairment was present in more than two-thirds (68.7%) of participants with visual impairment, while the overall amount of any uncorrected refractive error was 14.6%. The most significant determining risk factors were low and intermediate annual household income, defined as less than $20,000 per year and between $20,000 and $40,000, respectively.

According to the study authors, “… lobbying for a policy that would mandate vision care insurance within standard health insurance would seem to offer an easy policy path for addressing this issue.”

My Two Cents

Amen! No matter your thoughts on universal health care, a smartly designed benefit for all Americans that would entitle them to free essential eye care would be an incredible idea. Although far from perfect, this study shows that the most underserved Americans are living with correctable vision impairments. These patients are also in one of our largest cities, where eye care is relatively easy to find. What would similar studies show in some of our more rural areas? We often think that simple, uncorrected refractive errors are mostly found in third-world countries, and many of us pack our gear and head to these countries, armed with donated glasses to help the less fortunate. But we must remember and realize that these issues are just as prevalent here in our own country.

CAN YOU RELATE

I recently had the opportunity to volunteer here in Baton Rouge, Louisiana. An Idaho-based charity called Love Heals made its yearly trip to our area to help serve the less fortunate and those who don’t have access to essential health, dental, or eye care. In just a few hours, our small team served hundreds of patients, many of whom had never had an eye exam, and provided them with a basic eye exam, a free pair of glasses, and guidance on optimizing their ocular health.

Considering many of these patients were migrants who spoke little or no English, we were inundated with pterygiums and pinguecula, as well as quite a few exceptional cases, including a family with albinism who all had significant keratoconus, and a 27-year-old mother of four with end-stage glaucoma.

It was a wonderfully fulfilling day of charity work, and it reminded me that we don’t need to head to an exotic locale to help the less fortunate, because this work can be done within our own communities. As I mentioned in the newsletter a few weeks ago, now is a great time to share your blessings and skills with others. We are truly blessed to be a part of a profession that helps to give sight to the blind. Despite all our problems, we are the lucky ones. We have stable jobs with good incomes and face little risk to our health performing our careers. Others are not so lucky. Consider donating some of your time, talent, and treasure to enrich those who are not.