OSLI Retina

September 2020

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486 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Two-Year Outcomes Comparing Anti-VEGF Injections to Laser for ROP Using a Commercial Claims Database Michael H. Zhang, BS; Michael P. Blair, MD; Sandra A. Ham, MS; Sarah H. Rodriguez, MD, MPH BACKGROUND AND OBJECTIVE: To report ocu- lar 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) injec- tion identified in the MarketScan database (2011- 2017) with 2-year follow-up. RESULTS: A review of claims data found 298 pa- tients with International Classification of Dis- eases and Common Procedural Technology codes for ROP treatment and 2 years of continuous in- surance 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 comor- bidities (odds ratio = 1.88; P = .10). CONCLUSIONS: The prevalence of retinal detach- ment after 2 years was similar comparing anti- VEGF to laser. Despite the higher rates of un- derlying neurologic comorbidity in the injection group, there were no differences in language, mo- tor, or cognitive delays. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:486-493.] INTRODUCTION Big data extract and analyze information from da- tasets that are too large and complex to be dealt with by traditional methods. 1 Recent advances in analytical software have led to a revolution in making big data accessible. 1 One example of big data is the IBM Mar- ketScan Research Database (IBM, Armonk, NY), a na- tionwide database of insurance claims. This has previ- ously been used to describe glaucoma, strabismus, and retina surgical outcomes. 2-6 This database presents an unique opportunity to evaluate retinopathy of prematu- rity (ROP) outcomes, since existing national databases specific to ophthalmology lack data on patients with ROP. ROP is a leading causes of pediatric blindness. 7 For the past few decades, the standard of care for type 1 ROP has been laser peripheral retinal photocoagulation. 8,9 In 2011 the Bevacizumab Eliminates the Angiogenic Threat for Retinopathy of Prematurity (BEAT-ROP) study reported improved structural outcomes and lower rates of retinal detachment (RD) with intravitreal beva- cizumab (IVB) (Avastin; Genentech, South San Fran- cisco, CA) compared to traditional laser. 10 Significantly lower rates of myopia have also been reported. 11-13 From Pritzker School of Medicine, The University of Chicago, Chicago, Illinois (MHZ); the Department of Ophthalmology and Visual Science, The University of Chicago, Chicago, Illinois (MPB, SHR); Retina Consultants, Ltd., Des Plaines, Illinois (MPB); and the Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois, (SAH). Originally submitted February 24, 2020. Revision received May 19, 2020. Accepted for publication July 8, 2020. Presented at American Association for Pediatric Ophthalmology and Stra- bismus annual meeting, San Diego, California, March 2019, and the ROP Hot Topics meeting, Chicago, Illinois, October 2018. Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (Bethesda, MD) through Grant No. UL1 TR000430. The funding organizations had no role in the design or conduct of this research. The authors report no relevant financial disclosures. Address correspondence to Sarah H. Rodriguez, MD, MPH, Department of Ophthalmology, University of Chicago, 5841 S. Maryland Avenue, MC2114, Chicago, IL 60637; email: srodriguez5@bsd.uchicago.edu. doi: 10.3928/23258160-20200831-02

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