Changes in real world treatment patterns for diabetic macular edema and five year treatment outcomes: data from the Fight Retinal Blindness! Project

Abstract

Purpose : Treatment for diabetic macular edema (DME) has evolved over the last decade. We report the changes in treatment patterns for eyes with DME and their five-year treatment outcomes in real-world clinical practice through this observational study.

Methods : We analyzed 270 eyes (178 patients) that started treatment for DME from 2007-2012 tracked by the Fight Retinal Blindness! Project registry. We assessed changes in visual acuity (VA), central subfield thickness (CST) and number of injections in the 144 (53.3%) eyes that had five years of observation.

Results : Treatment choice changed from mostly laser and intravitreal steroid injections in 2007 to predominantly intravitreal vascular endothelial growth factor (VEGF) inhibitor injections from 2011 onwards (Figure 1). The mean VA at the start of treatment improved progressively from 53 letters in 2007 to 67 letters in 2012 (Figure 2). The mean VA change at 5 years was 0.1 letters, 17% gained ≥15 letters and the proportion of eyes with VA≥70 letters (20/40) increased from 49% to 54%. The mean CST dropped from 399µm to 314µm at 5 years. Eyes received a median of 3 injections in the first year, 2 in the second and third year, 3 in the fourth year and 4 in the fifth year.

Conclusions : We found a swing towards intravitreal therapy with VEGF inhibitors from 2007 to 2012. VA outcomes improved, mainly because VA at the start of therapy was better. Eyes in real-world practices received fewer injections and the visual outcomes were inferior to clinical trials.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1. Stacked bar plot showing the proportions of treatments used for diabetic macular edema for initial therapy and at follow up visits.

 

Figure 2. Mean change in visual acuity at 60 months after starting treatment in eyes with diabetic macular edema from 2007 – 2012.