Abstract
Purpose :
Clinical trials of anti-VEGF intravitreal therapy as a treatment for diabetic macular edema (DME) have achieved visual acuity improvements that have not been replicated in the real-world clinical setting. In this retrospective interventional cohort study we report the post-treatment visual acuity changes of treatment-naïve patients over a 1-year period.
Methods :
We analysed medical records of patients referred from National Diabetic Retinal Screening Programme (RetinaScreen) who received anti-VEGF injections from November 2015 to March 2018. We recorded the patients’ type of diabetes, visit dates, corrected Snellen acuity, OCT central subfield thickness (CST), and any adjunct ocular procedures performed during the study period. Eyes that were prescribed anti-VEGF therapy for CRVO, BRVO, or ARMD were excluded. Snellen acuity measurements were converted into LogMAR acuity for statistical analysis.
Results :
During the study interval 4725 referrals were made to the Mater Hospital Diabetic Retina Treatment Centre (DRT) for further evaluation and treatment. 108 patients (28 binocular, 80 monocular) were treated with anti-VEGF injections for centre-involving DME (Ci-DME).
For this analysis, 60 treatment-naïve Ci-DME patients contributed 71 eyes (11 binocular, 49 monocular). In the 365 days post-index injection period a mean (SD) of 3.6 (1.3) bevacizumab injections were given per eye (range 1-7, median = 3). Mean baseline best measured visual acuity of the cohort was 0.52 LogMAR or 59 ETDRS letters. Mean (SD) visual acuity gain was +3.31 (19) letters. 21% of the cohort gained more than 10 letters, while 8.5% lost more than 10 letters. 72.5% of the patients maintained their visual acuity within 10 letters of their baseline vision. Mean (SD) CST was 435um (124), which reduced by mean (SD) -37um (117) post-treatment.
Conclusions :
In this cohort, patients did not achieve the frequency of injections recommended in clinical trials in spite of clinical guidelines. An injection frequency of 3.6 injections per eye per year has yielded a mean 3.3 letters improvement. Data from other treatment centers with similar frequency of injections show similar improvements. More effort is needed to ensure patients get the required injections (and/or agent) to optomize visual improvement.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.