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Bevacizumab for non-ischaemic central retinal vein occlusion and branch retinal vein occlusion
|Commissioning decision |The CCG will provide funding for Bevacizumab for non-ischaemic central retinal vein occlusion and branch retinal vein|
| |occlusion |
| |For patients who meet the criteria defined within this policy. |
|Qualifying for Treatment |
| |
|1. Bevacizumab is commissioned for the treatment of non-ischaemic central retinal vein occlusion is restricted to patients meeting the following |
|criteria: |
| |
|Patient has previously lost vision in one eye with best corrected visual acuity below 6/18 and now presents with CRVO in their other eye. |
|AND |
|Best corrected visual acuity in their CRVO eye is 6/18 or worse. |
|AND |
|The patient has been observed for spontaneous improvement for at least 3 mths after the first symptoms of occlusion. |
|AND |
|The patient has perfused (non-ischaemic) CRVO: there is no evidence of ischaemia at the macula on fluoroscein angiography. |
|AND |
|There is no evidence of eye disease that reduces the likelihood of successful treatment in the CRVO eye. |
| |
|Discontinuing Treatment |
| |
|2. Treatment will be permanently discontinued if the following criteria are met: |
| |
|There is resolution of macular oedema AND visual acuity is improved after a single injection. |
|OR |
|Three doses have been given at intervals of 6 wks, but there is no improvement in visual acuity despite resolution of macular oedema. |
| |
| |
|Usual Treatment Regimen and Further Treatment |
| |
|3. The usual course of treatment will be up to 3 doses of intravitreal bevacizumab. Further doses will be given only if: |
| |
|The patient’s visual acuity and macular oedema previously responded to treatment; |
| |
|AND |
|The patient now reports deterioration in vision with a recurrence of fluid at the macula. |
| |
|Further Restrictions and Requirements |
| |
|4 Changes in central retinal thickness without deterioration in visual acuity will not be a criterion for starting or resuming treatment. |
| |
|5 Patients treated within this policy will be included in prospective, departmental clinical audit including all criteria specified above and adverse |
|events (ocular and systemic). |
| |
|6 The prescribing clinician must meet the governance requirements for using drugs off-label |
|( ) including obtaining informed consent from the patient and understands that |
|responsibility for prescribing drugs outside the terms of the product licence remains with the prescriber. |
Plain English Summary
|Policy review date |July 2022 |
Version Control
|Version No |Type of Change |Date |Description of Change |
|1 | | |First publication |
|2 |Date change |21.6.18 |Review date changed to June 2019 |
|3 |Date change |17.9.19 |Review date changed to Sept 2020 |
|4 |Date & wording |11.6.20 |Review date changed to July 2022 and Plain English Summary |
| | | |updated. |
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Policy Category
CBA
Who usually applies for funding? Not applicable
What is central retinal vein occlusion / branch retinal vein occlusion
Tiny blood vessels supply the retina with oxygen and other nutrients. Arteries deliver the blood, and the retinal veins carry it out. Sometimes a vein can then become blocked, or occluded, making it difficult for blood to leave the eye. There are two types of retinal vein occlusion – branch and central. Branch retinal vein occlusion is when the blockage occurs somewhere along one of the four retinal veins (one vein drains each quarter of the eye). Central retinal vein occlusion is a blockage in the main veins that is formed by the four branch veins coming together.
What is Bevacizumab (Avastin)
Bevacizumab is a drug that blocks a substance called vascular endothelial growth factor (VEGF) which stimulates the growth of new blood vessels in the eye.
What does the policy mean for me?
Bevacizumab is not licenced in the UK for treating any eye conditions. However, there is some evidence to show a positive impact for patients with retinal vein occlusion. Therefore, it is sometimes made available to patients through the NHS. This policy sets out the clinical criteria that a patient needs to meet in order to access this treatment. If your doctor believes that you meet the criteria set out in the policy the treatment would be funded by the NHS.
Policy Category
CBA
Who usually applies for funding? Not applicable
Glossary of clinical terms contained within the policy
• Best Corrected Visual Acuity - best corrected visual acuity is a measurement of the best vision that can be achieved through correction such as glasses.
• Fluorescein angiography - A fluorescein angiography is a medical procedure in which a fluorescent dye is injected into the bloodstream. The dye highlights the blood vessels in the back of the eye so they can be photographed.
• Macula - The macula is part of the retina at the back of the eye. It is only about 5mm across but is responsible for all of our central vision, most of our colour vision and the fine detail of what we see.
Macular oedema - Macular oedema occurs when fluid and protein deposits collect within the macula, leading to thickening and swelling which distorts central vision. It can cause permanent vision loss if left untreated.
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