Myopic Macular Neovascularization Twice as Common in Women, Study Finds

While aflibercept and ranibizumab were the main treatments of myopic macular neovascularization, the authors of a recent study noted that uptake of ranibizumab biosimilars in recent years suggests growing interest in cost-effective alternatives. Photo: Julie Poteet, OD. Click image to enlarge. With the increasing prevalence of myopia, especially in Asia, the societal burden of myopic macular neovascularization (mMNV) continues to grow. However, despite the considerable impact of mMNV, data on its incidence, treatment patterns and clinical characteristics have been limited and inconsistent. In a recent study, researchers investigated all of these using a Japanese population and found a higher prevalence in women. Also notable were a to-be-expected drop in the number of cases diagnosed during the COVID-19 pandemic and the potential for cost-effective anti-VEGF biosimilars to play an increasing role in management. The findings were reported in Ophthalmology Science.A total of 45,671 individuals with new-onset mMNV covered by the Japanese national health insurance system between January 2016 and December 2022 were identified, with 70.7% of cases occurring in women.There was a temporary decline in newly diagnosed mMNV cases in 2020, which the authors attribute to the COVID-19 pandemic due to reduced clinic visits and stay-at-home orders. “This phenomenon underscores the impact of pandemic-related behavioral changes on disease detection rates, suggesting that some individuals with mMNV might have delayed or missed seeking treatment during the height of the outbreak,” the authors wrote in their Ophthalmology Science paper.Women not only accounted for a larger proportion of mMNV cases but also had a later onset age compared with men. “Although previous research has suggested that hormonal influences, genetic factors and lifestyle habits contribute to the higher prevalence of mMNV in women, the specific mechanism explaining the later onset in women remains unclear,” the authors explained in their paper. “Estrogen receptor expression has been reported in choroidal neovascular membranes, implying that menopausal changes may play a role.”The authors also assessed the initial treatment patterns for mMNV, focusing on the use of anti-VEGF therapy. In total, 52.6% of newly diagnosed patients with mMNV received anti-VEGF treatment (43.5% ranibizumab, 56.5% aflibercept). The number of injections in the first, second and third years after the initial injection was 2.45, 0.62 and 0.46, respectively. Additionally, during the second and third years, patients received an average of 0.5 additional injections annually in response to recurrences, offering new insights into the practical management of mMNV.“In Japan, ranibizumab and aflibercept were covered by insurance at the start of the study period in 2015,” the authors noted in their paper. “Consequently, during the study period the off-label use of bevacizumab was minimal, and under Japan’s universal healthcare system, virtually all treated cases of mMNV were captured, allowing for a precise evaluation of treatment patterns.”Use of aflibercept declined somewhat after the introduction of ranibizumab biosimilars, possibly due to their lower cost and demonstrated equivalence.The authors explained that because Japan’s universal healthcare system emphasizes cost containment and implements corresponding policies, the gradual replacement of higher-priced agents with biosimilars is not unexpected. In addition, prescribing patterns of physicians may be influenced by growing confidence in the efficacy and safety profiles of biosimilars.“The observed shift toward biosimilars may inform future policy decisions regarding drug pricing and accessibility,” the authors concluded in their study. “Further multinational studies using comparable real-world data are warranted to validate these patterns and optimize mMNV care globally.” Click here for the journal source. Akada M, Miyake M, Hata M, et al. Incidence and clinical practice of myopia macular neovascularization: a nationwide population-based cohort study. Opthalmol Sci. May 26, 2025. [Epub ahead of print.]