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Jeffrey Ryuta Willis, Lawrence S Morse, William Rich III, Flora Lum, Craig Salman, Ronald A Cantrell; Treatment patterns for diabetic macular edema (DME) in the United States: Analysis of the IRIS® Registry (Intelligent Research in Sight). Invest. Ophthalmol. Vis. Sci. 2018;59(9):2604. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
DME is a vision threatening complication of diabetes. There are few national-level data derived from large-scale studies that describe how ophthalmologists in the US manage treatment-naïve DME. This analysis uses data from the AAO’s IRIS Registry to characterize the real-world treatment patterns surrounding incident DME in the US.
This was a retrospective cohort study. Eligible patients were aged ≥18 years with a new diagnosis of DME (index date) between July 1, 2013 and March 31, 2016 with at least 180 days of eligibility data prior to, and at least 365 days of follow-up data following, the index date. Outcome measures included type of initial treatment received, number of office visits, anti-VEGF injection burden, and changes in visual function.
Of 197,220 individuals identified in the IRIS registry, 13,410 eligible newly-diagnosed, treatment-naïve cases of DME were included in the analysis (mean age 65.4 ± 11.5 years; 47.1% male; 51.2% bilateral DME). Treatment received within 28 days of diagnosis: None 9990 (74.5%); anti-VEGF 2091 (15.6%); laser surgery 1133 (8.5%); corticosteroid 130 (1.0%); combination treatment 66 (0.5%). After 28 days following diagnosis, the majority of the 9990 patients who received no treatment continued to receive no treatment (8094; 81.0%), 1064 (10.6%) received delayed anti-VEGF, 708 (7.1%) received delayed laser surgery, 109 (1.9%) received delayed corticosteroids and 15 (0.1%) received combination treatment. Among those who initiated anti-VEGF within 28 days of diagnosis (n=2091), the mean (SD) number of injections administered over the 1 year of follow-up was 4.2 (2.9), while 49.8% received 3 injections or fewer over the 1-year follow-up period. Data on office visits and changes in visual acuity during the first year following diagnosis will also be presented.
Data from this large-scale, real-world data source show that the majority of patients with newly-diagnosed treatment-naïve DME appear to receive no treatment during the initial year after diagnosis. When treatment is given, anti-VEGF injections appear to be the treatment of choice. Future research is needed to understand the barriers to treatment and interventions that could address these barriers.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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