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Vignesh Vetrivel, Dawn A Sim, Pearse Andrew Keane, Mirjam EJ Van Velthoven, Javier Zarranz-Ventura, Florian M Heussen, Matthias Bolz; Clinical applications of the SAVE grading protocol for diabetic macular edema based on optical coherence tomography and fluorescein angiography criteria. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1785.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the application of a new grading protocol for clinically significant macular edema (DME).
A pilot study, which included patients who underwent fluorescein angiography (FA) and optical coherence tomography (OCT), and laser therapy for diabetic macular edema. Patients were grouped according to their response to macular laser. A response to treatment was defined as a reduction in OCT-derived central macular thickness (CMT) of >20µm. FA and OCT images were graded according to the following modified “SAVE” criteria: “S” - Subretinal fluid (score: present=1, absent=0); “A” - The Area of retinal thickening (score: greater than one disc diameter=1, less than one disc diameter=0; “V” - Vitreomacular abnormalities (score: present=1, absent=0); and “E” - the Etiology of DME (Score: the presence of focal or diffuse leakage= 0 or 1 respectively, diabetic macular ischemia=1, and retinal atrophy=1). The range of possible modified SAVE scores was 0 to 6.
48 eyes from 48 patients were included. In all patients, the modified SAVE score was correlated to change in CMT measurements after macular laser therapy (r=-0.29, p=0.05). A poor visual acuity prior to laser therapy was also associated with a high modified SAVE score (r=0.56, p=0.002). The mean reduction in CMT measurements of responders to macular laser (n=20) was 99.7±56.9µm, and the mean increase in CMT of non-responders (n=28) was 65.1±80.7µm (p=0.0001). Responders to macular laser had a lower modified SAVE score (mean=2.4, 95% CI=1.79 to 3.01), compared to non-responders (mean=3.2, 95% CI=2.60 to 3.82) (p=0.05).
We present a simplified version of the “SAVE” grading protocol for diabetic macular edema, and assess it’s clinical usefulness and potential application to patients undergoing macular laser therapy for diabetic macular edema. We observed that the modified SAVE score was associated with both responsiveness to treatment and pre-morbid visual function.
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