June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Fluctuations in Macular Thickness in Patients with Diabetic Macular Edema treated with Anti- Vascular Endothelial Growth Factor Agents
Author Affiliations & Notes
  • Victoria Y Wang
    Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
  • Blanche Kuo
    Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
  • Andrew Xie Chen
    Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Kevin Wang
    Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Tyler Greenlee
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Thais F Conte
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Rishi P Singh
    Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
    Center for Ophthalmic Bioinformatics, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Victoria Wang, None; Blanche Kuo, None; Andrew Chen, None; Kevin Wang, None; Tyler Greenlee, None; Thais Conte, None; Rishi Singh, Alcon/Novartis (C), Apellis (F), Bausch + Lomb (C), Genentech/Roche (C), Graybug (F), Regeneron Pharmaceuticals, Inc. (C), Zeiss (C)
  • Footnotes
    Support  This study was supported in part by the NIH-NEI P30 Core Grant (IP30EY025585), Unrestricted Grants from The Research to Prevent Blindness, Inc., and Cleveland Eye Bank Foundation awarded to the Cole Eye Institute.
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1050. doi:
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    • Get Citation

      Victoria Y Wang, Blanche Kuo, Andrew Xie Chen, Kevin Wang, Tyler Greenlee, Thais F Conte, Rishi P Singh; Fluctuations in Macular Thickness in Patients with Diabetic Macular Edema treated with Anti- Vascular Endothelial Growth Factor Agents. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1050.

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

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Abstract

Purpose : There are currently no dependable ways to predict visual outcomes in patients with diabetic macular edema (DME) who are being treated with anti-vascular endothelial growth factor (VEGF) injections. Identification of biomarkers that are predictive of visual outcomes is crucial for the clinical management of DME. The purpose of this study was to test the hypothesis that patients with greater retinal thickness fluctuations have worse visual outcomes.

Methods : This retrospective cohort study analyzed 270 DME patients seen at the Cleveland Clinic Cole Eye Institute from 2012 to 2019 based on the following inclusion criteria: initiation of anti-VEGF therapy during the study period without prior anti-VEGF treatment, follow-up for at least 12 months after first injection, no concomitant maculopathies, and no concurrent steroid injections or focal laser photocoagulation treatment received. Visual acuity (VA) and central subfield thickness (CST) were collected at 0, 3, 6, 9, and 12 months for each patient. Retinal thickness fluctuation was quantified by the standard deviation (SD) of CST across 12 months. Eyes were stratified into quartiles based on CST SD, and 12-month VA was compared. A mixed effects regression model was also used to evaluate the relationship between CST SD and VA at 12 months.

Results : Mean baseline and 12-month VAs were 63.3 ± 15.7 and 68 ± 13.8 ETDRS letters (p<0.001). Mean baseline and 12-month CST were 401.8 ± 124.9 and 337.1 ± 101.0 μm (p<0.001). Mean CST SD was 61.8 ± 52.5 μm. CST SD was a significant negative predictor of 12-month VA (p<0.001) when adjusting for baseline factors, demographics, injections, DR stage, HbA1c, and insulin dependence.

Conclusions : Larger retinal thickness fluctuations are associated with poorer visual outcomes in eyes with DME treated with anti-VEGF injections. Retinal thickness variability may be an important prognostic biomarker for DME patients and may aid in the evaluation of these patients’ progress in clinical practice.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure 1. Visual Acuity Stratified by Retinal Thickness Variability. (A) Actual 12-month VA stratified by CST SD quartiles. (B) Predicted 12-month VA using a mixed effects regression model, stratified by CST SD quartiles, adjusted for demographics, number of treatments, and baseline variables. Error bars represent the standard deviation of each quartile.

Figure 1. Visual Acuity Stratified by Retinal Thickness Variability. (A) Actual 12-month VA stratified by CST SD quartiles. (B) Predicted 12-month VA using a mixed effects regression model, stratified by CST SD quartiles, adjusted for demographics, number of treatments, and baseline variables. Error bars represent the standard deviation of each quartile.

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