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Thomas A Ciulla, David F. Williams; Real World U.S. Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2025.
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© ARVO (1962-2015); The Authors (2016-present)
To assess "real world" visual acuity (VA) outcomes of anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME).
Analysis was performed on a large database of aggregated, longitudinal EMR from a demographically diverse sample of U.S. retina specialists. The HIPAA-compliant Vestrum Health Retina Database was used retrospectively. DME patients who underwent at least 3 monthly anti-VEGF injections between January 2011 and April 2016 were eligible. The eyes were divided into 3 groups based on choice of initial anti-VEGF agent. These eyes were then subdivided into three cohorts: those with records including VA measurements up to and including 6-months but not beyond (“6-month cohort”), up to 12-months but not beyond ("12-month cohort”), and up to and including 24 months (“24-month cohort”), with each cohort being mutually exclusive. VA outcomes were assessed on each cohort and also stratified by baseline VA.
5872 patients were included in this analysis. In the 12-month cohort (mean age 62 years), for 1262 patients who initially underwent treatment with bevacizumab, the mean 12-month improvement was 6.0 letters after an average of 8.6 injections, compared to ranibizumab (609 patients, 6.1 letters, 8.4 injections), and aflibercept (444 patients, 7.4 letters, 8.5 injections). The mean number of macular laser and pan retinal laser treatment sessions was similar in each group (≤0.26 each). In the 12-month cohort, when stratified by baseline VA of 20/201 or worse, 20/71-20/200, 20/41-20/70, and 20/40 or better, the final mean change in number of letters gained or lost in the bevacizumab initially group was +37.3, +8.7, +3.0, and -2.3 letters respectively, in the ranubizumab initially group was +31.3, +10.2, +4.5, and -1.9 letters respectively, and in the aflibercept initially group was +36.6, +11.3, +4.3, -2.0 respectively. Treatment duration, comparing the 6-, 12-, and 24-month cohorts, showed no significant trends with visual acuity outcomes.
Visual outcomes following anti-VEGF therapy for DME in the “real world” do not achieve those seen in randomized clinical trials. Eyes with better baseline VA are disproportionately affected. There was no significant difference in outcomes based on choice of initial anti-VEGF agent. Duration of treatment did not correlate with visual outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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