June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Visual outcomes in Eyes Lost to Follow Up with Diabetic Macular Edema treated with Anti-Vascular Endothelial Growth Factor
Author Affiliations & Notes
  • Douglas Matsunaga
    Wills Eye Hospital , Philadelphia, Pennsylvania, United States
  • Connie M Wu
    Wills Eye Hospital , Philadelphia, Pennsylvania, United States
  • Anthony Obeid
    Wills Eye Hospital , Philadelphia, Pennsylvania, United States
  • Turner David Wibbelsman
    Wills Eye Hospital , Philadelphia, Pennsylvania, United States
  • Jason Hsu
    Wills Eye Hospital , Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Douglas Matsunaga, None; Connie Wu, None; Anthony Obeid, None; Turner Wibbelsman, None; Jason Hsu, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4878. doi:
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      Douglas Matsunaga, Connie M Wu, Anthony Obeid, Turner David Wibbelsman, Jason Hsu; Visual outcomes in Eyes Lost to Follow Up with Diabetic Macular Edema treated with Anti-Vascular Endothelial Growth Factor. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4878.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Large clinical trials have established anti-VEGF as the first-line therapy for diabetic macular edema (DME), however these outcomes were established in the setting of strict adherence to trial protocols while real world studies have found loss to follow up to be a common treatment challenge. We sought to evaluate the visual and anatomic outcomes of DME patients treated with anti-VEGF who were lost to follow up (LTFU) during their treatment course.

Methods : Retrospective consecutive case series including 57 eyes of 43 DME patients who were LTFU for at least six months. Baseline patient characteristics, anti-VEGF treatment history, history of focal laser, visual acuity, and OCT measurements were obtained prior to LTFU, at first return date, 3 months after return, 6 months after return, 12 months after return, and final visit on record. Statistical analysis comparing continuous variables were made using a generalized estimating equation to account for intercorrelation between 2 eyes from the same patient.

Results : The mean age was 63.4 years with 28.1% having a history of focal laser. The average LTFU time was 373 days, and the average follow up time after return from LTFU was 354 days. There was a significant worsening in the mean logMAR VA (SD) at the return visit [0.55 (0.42), Snellen ~20/71] (p<0.001), the 12-month after return visit [0.44 (0.28), Snellen ~20/55] (p=0.007), and the final visit [0.49 (0.35), Snellen ~20/62] (p=0.009) when compared to the visit before LTFU [0.41 (0.27), Snellen ~20/51]. There was a significant increase in the mean CFT (SD) at the return visit [323 mm (171)] (p=0.02) when compared to the visit before LTFU [279 mm (118)]. There was no significant increase in the mean CFT at the final visit [294 mm (149)] (p=0.47) compared to before LTFU.

Conclusions : DME patients had a significant worsening in visual acuity and CFT after LTFU. After restarting anti-VEGF therapy, CFT was found to improve to statistically similar levels as prior to LTFU. However, while visual acuity was found to improve it did not attain levels seen prior to LTFU. These findings suggest that prolonged treatment breaks lead to reduced long term visual potential independent of macular edema and reinforces the importance of treatment adherence in DME.

This is a 2020 ARVO Annual Meeting abstract.

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