June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
5-year treatment patterns in patients with DME following intravitreal (IVT) anti-VEGF therapy
Author Affiliations & Notes
  • Vincent Garmo
    Genentech Inc, South San Francisco, California, United States
  • Parisa Emami-Naeini
    UC Davis Eye Center, Sacramento, California, United States
  • Nicholas Boucher
    Vestrum Health, Ottawa, Ontario, Canada
  • Rusirini Fernando
    Vestrum Health, Ottawa, Ontario, Canada
  • Alicia Menezes
    Genentech Inc, South San Francisco, California, United States
  • Footnotes
    Commercial Relationships   Vincent Garmo, Genentech, Inc. (E); Parisa Emami-Naeini, None; Nicholas Boucher, Vestrum Health (E); Rusirini Fernando, Vestrum Health (E); Alicia Menezes, Genentech, Inc. (E)
  • Footnotes
    Support  Genentech, Inc., South San Francisco, CA, provided support for the study and participated in the study design; conducting the study; and data collection, management, and interpretation
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1060. doi:
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      Vincent Garmo, Parisa Emami-Naeini, Nicholas Boucher, Rusirini Fernando, Alicia Menezes; 5-year treatment patterns in patients with DME following intravitreal (IVT) anti-VEGF therapy. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1060.

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

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Purpose : To describe the long-term impact of treatment (tx) regimens on vision outcomes in patients (pts) with diabetic macular edema (DME) who received IVT anti-vascular endothelial growth factor (VEGF) therapy from a large US electronic health record (EHR) database.

Methods : EHR data (Vestrum Health; 01-01-2014 to 06-30-2020) were analyzed. Tx naïve pts were followed for 5 yrs from first tx (i.e. index) with IVT anti-VEGF. Pts were stratified by baseline visual acuity (VA) and also evaluated for other DME-related tx, including IVT steroids, focal laser, and pan-retinal photocoagulation (PRP).

Results : 1657 eyes were stratified and analyzed by index VA. On average, pts received 6.8 anti-VEGF injections in yr 1, and ~4 injections per yr in following yrs. Overall, pts gained 4.0 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline to 5 yrs (65.6 vs 69.6 letters; ~ 20/40 Snellen), though pts lost roughly 3 letters from their peak of 72.5 letters at yr 1. 80% of pts with ≥20/40 index VA were able to maintain VA of ≥20/40 at 5 yrs, while only 58%, 31%, and 30% of pts with 20/40–20/100, 20/100–20/200 and <20/200 index VA, respectively, were able to reach ≥ 20/40 at 5 yrs (Fig 1). At the end of yr 1, pts who received 1–4 (28%), 5–6 (17%), 7–8 (20%), and ≥9 (35%) injections in the first yr gained 2.9, 7.6, 7.9, and 9.4 letters, respectively. Pts receiving 1-4 injections in yr 1 had the highest baseline VA (67.0 vs. 64.3 letters in ≥9 group), but had the lowest VA at yr 5 (68.1 vs. 70.7 letters in 9+ group) (Fig 2). More injections correlated with improved VA (P < 0.001). In subsequent yrs, VA was mostly lost or unchanged (−1.2, −0.9, 1.1, and −0.8 letters at yr 3; −1.7, −0.5, −0.4, and 0.2 at yr 5). 33% of pts received laser tx (focal or PRP) in yr 1, dropping to 16%,11%, 7% and 5% in yrs 2,3,4 and 5, respectively.

Conclusions : Overall, pts with DME gained vision through 5 yrs, but were not able to maintain peak vision following yr 1 of tx. More injections were associated with improved VA gains at yr 1 and beyond, suggesting increased injections could result in lasting improved vision. Pts with ≥20/40 index vision, and pts receiving more injections at baseline maintained better overall vision throughout the study, suggesting that early and frequent tx is likely to result in optimal long-term vision.

This is a 2021 ARVO Annual Meeting abstract.


Fig 1. Mean VA over 5 yrs by index vision

Fig 1. Mean VA over 5 yrs by index vision


Fig 2. Mean VA over 5 yrs by yr 1 injection frequency

Fig 2. Mean VA over 5 yrs by yr 1 injection frequency


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