NICE recommends new treatment for sight-threatening macular oedema secondary to branch retinal vein occlusion

NICE has recommended aflibercept (Eylea) as a cost-effective first-line treatment for adults with visual impairment due to macular oedema secondary to branch retinal vein occlusion (BRVO) within a draft Final Appraisal Determination (FAD).

In the draft guidance NICE concluded that aflibercept is more clinically effective than laser photocoagulation, the existing first-line treatment, for untreated visual impairment caused by macular oedema after BRVO. It also said that aflibercept is more clinically effective when given before, rather than after, laser photocoagulation. 

The final decision will be made in October, but it is hoped more than 13,000 patients will have access to this effective treatment option. Aflibercept will become the only medicinal product currently approved by NICE as a first-line treatment option for visual impairment due to macular oedema secondary to BRVO once the draft guidance is finalised. 

Professor Sobha Sivaprasad, Consultant Ophthalmologist, Moorfields Eye Hospital, London, said: “This is great news for the clinical community as it means we will be able to offer patients with BRVO the same opportunity to achieve improvements in vision, as those with other retinal conditions. BRVO can rapidly cause damage to eye sight so it is hugely important that we are able to treat patients effectively and as soon as possible. In the UK, however, we have been limited to treating BRVO patients with laser at diagnosis and this often does not achieve the desired improvements in vision. First-line access to an anti-VEGF injection will allow us to promptly offer patients effective treatment. This recommendation will also mean that treatment decisions could be simplified, with fewer interventions and NHS resources required to ensure patients are achieving the best possible visual outcomes.”

BRVO is caused by a blood clot in one of the branches of the main vein in the retina, the light sensitive layer at the back of the eye. Blockages in the retinal veins increase the pressure in the small blood vessels at the back of the eye, which can lead to blood and fluid leaking beneath the macula (macular oedema). If not treated effectively, macular oedema secondary to BRVO can significantly impact a person’s vision. This loss in vision can severely affect independence, confidence and the ability to undertake daily activities, meaning patients become increasingly dependent on family and carers.

Cathy Yelf, Chief Executive, Macular Society, said: “It is great news that patients will have access to an anti-VEGF treatment at the start of the treatment journey, as it will mean that they will not have to go through the pain and discomfort that can often be associated with laser treatment and will have the opportunity to preserve their eye sight as much as possible so they are able maintain their independence and the quality of life.” 

Aflibercept is an anti-VEGF treatment specifically designed to rapidly deliver sustainable improvements in vision, while offering patients and healthcare professionals a predictable dosing programme. It is licensed in the UK for the treatment of wet age-related macular degeneration (wAMD), visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO) and BRVO, visual impairment due to diabetic macular oedema (DMO) and myopic choroidal neovascularisation (mCNV). Funding for aflibercept is mandated across England and Wales for the treatment of eligible patients with wAMD, visual impairment due to macular oedema secondary to CRVO and DMO and in Scotland for all licensed indications except mCNV.