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Joanna Campbell, Ashley L Cole, Arghavan Almony, Herbert Ingraham, Nancy M Holekamp, Steven Marks, Hitesh Chandwani, Jonathan W Kowalski, Szilard Kiss; Real World Vision Outcomes in DME Treated with Anti-VEGF Injections - An Analysis of EMR Data From a Large Health System. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3065.
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Prior studies have demonstrated less frequent anti-vascular endothelial growth factor (anti-VEGF) utilization in retinal diseases in clinical practice compared with landmark randomized controlled trials (RCTs). The purpose of this study is to further assess real-world vision outcomes for anti-VEGFs in the treatment of Diabetic Macular Edema (DME).
This is a retrospective study of electronic medical records from an integrated health system in the United States. Eyes of DME patients receiving initial treatment with intravitreal ranibizumab or bevacizumab from Jan 2007 to May 2012 were included, with corrected visual acuity (CVA) from 20/40-20/400 at index treatment (baseline) and ≥2 visits within the 12-month follow-up. Data from missing visits (but not invalid data at visits) were imputed by last observation carried forward (LOCF). Snellen visual acuities were converted to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale using a published algorithm. The number of anti-VEGF injections, change in CVA from baseline, and proportions of eyes improving or losing ≥2 or ≥3 lines were assessed at 12 months. Analyses were performed on observed and LOCF data.
One hundred and three eyes met the inclusion criteria with mean (SD) CVA of 53.8 (15.0) letters at baseline. Eighty-two eyes had a follow-up visit at 6 months, with 77 eyes at 12 months. At 12 months: the mean number of anti-VEGF injections was 2.7; mean change in CVA was 5.4 letters (LOCF); proportions of eyes gaining ≥2 and ≥3 lines were 28.9% and 24.1% (LOCF); and the proportions of eyes losing ≥2 and ≥3 lines were 14.5% and 10.8%, respectively. Outcomes in the observed population were similar to LOCF (Table 1).
In this large health care system retrospective study, frequency of intravitreal injections and subsequent visual acuity improvement in clinical practice are lower than reported in landmark RCTs like RISE/RIDE. Prior studies demonstrating less frequent DME anti-VEGF injections than in RCTs hypothesized that vision improvement might also be lower. This study links less frequent anti-VEGF injections to less visual acuity improvement. Additional research is needed to assess factors that may affect utilization of anti-VEGF injections, and patient characteristics that may affect vision outcomes such as underlying diabetes control.
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