Trends in diabetic macular edema therapy at a single academic institution

Abstract

Purpose : While anti vascular endothelial growth factor (anti-VEGF) agents for diabetic macular edema (DME) have demonstrated superiority over focal laser in improving vision in repeated randomized control trials, few studies have reported on the results in typical clinical settings. We investigated the “real-world” effectiveness of DME therapy by analyzing trends of management and outcomes of patients diagnosed with DME at a large, single academic institution.

Methods : A retrospective cohort study of all incident cases of DME at the Scheie Eye Institute of the University of Pennsylvania from 2009-2014 was performed. Change in visual acuity (VA), central retinal thickness on OCT, use of various therapies (ie focal lasers, anti-VEGF agents) and ancillary tests (ie OCT, fluorescein angiography, fundus photos) were calculated, as were the number of visits over a period of two years. Mean differences in cohorts were tested with ANOVA or Kruskal-Wallis equality-of-populations rank test based on variances. Categorical variables were tested with chi-squared tests.

Results : During the study period, 219 patients total were included. A decline in percent of patients receiving focal laser (56% in 2009 and 32% in 2013, p=0.031) and a rise in patients receiving intravitreal injections (30% in 2009 and 58% in 2013, p=0.031) was seen over the study period. For each year studied, patients received on average 1.0-1.15 lasers/year or 2.50-4.31 injections/year. The number of patients receiving OCTs rose over time, while the number of patients receiving fundus photos and fluorescein angiography remained stable. The number of DME visits remained stable through the 5-year study period, ranging from 4 to 5.32 visits/year. For all levels of VA, the improvement with therapy over time was between 0 and 5 letters and not statistically significant (p=0.487). For levels of VA 20/40 or worse, there was greater improvement and even reached 9 letters in one cohort, but was only 3 and 7 in the others (p=0.257).

Conclusions : Despite the changing trends in DME care, the current therapy received and number of office visits is far less than evidenced-based protocols. This, in conjunction with the visual acuity results, suggests possible undertreatment of DME in a real-world clinical setting.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.