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John R. Gonder, Valery Walker, Nancy Zaour, Martin Barbeau, Lauren Hemsley, Ruihong Li; C-REALITY (Canadian Burden of Diabetic Macular Edema Observational Study). Invest. Ophthalmol. Vis. Sci. 2012;53(14):6933.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize the economic and societal burden of Diabetic Macular Edema (DME) in Canada.
Patients with clinically significant macular edema (CSME) were enrolled by ophthalmologists and retinal specialists across Canada. Patients were followed over a 6-month period to combine prospective data collected during monthly telephone interviews and at sites at months 0, 3 and 6. Visual acuity (VA) was measured and DME-related health care resource information was collected. Patient health-related quality of life (HRQOL) was measured using the National Eye Institute Visual Functioning Questionnaire (VFQ-25), and the EuroQol Five Dimensions (EQ-5D).
A total of 145 patients [mean age 63.7 years (range: 30-86 yrs); 52% male; 81% Type 2 diabetes; mean duration of diabetes 18 years (range: 1-62 yrs); 72% bilateral CSME] were enrolled from 16 sites across 6 provinces in Canada. At baseline, the mean VA was 20/60 (range: 20/20-20/800) across all eyes diagnosed with CSME (249 eyes). Sixty-eight percent of patients had VA severity in the worse seeing eye of normal/mild vision loss (VA 20/10 to ≥ 20/80), 19% moderate vision loss (VA < 20/80 to ≥ 20/200), and 13% severe vision loss/nearly blind (VA < 20/200). Over the 6-month period, 11% of patients received one or more steroid injection, 29% received one or more anti-VEGF injection, 57% received laser photocoagulation, and 6% received vitrectomy. At month 6, the mean VFQ-25 composite score was 79.6 (scores range from 0 to 100 with higher scores represent better functioning), the mean EQ-5D utility score was 0.78 (0 represents death and 1 represents perfect health), and the EQ visual analogue scale (VAS) score was 71.0 (0 represents the worst imaginable health state and 100 represents the best). The average 6-month DME-related cost per patient was $2,092 across all patients (95% confidence interval: $1,694 to $2,490). The cost was $1,820 for patients with normal/mild vision loss, $2,911 for patients with moderate vision loss, and $2,304 for patients with severe vision loss/nearly blind.
DME is associated with limitations in functional ability and quality of life. In addition, the DME-related cost is substantial to the Canadian health care system.
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