Natural History and Predictors of Vision Loss in Eyes with Diabetic Macular Edema and Good Initial Visual Acuity

Abstract

Purpose : To identify clinical and anatomic factors associated with vision loss in the eyes with treatment-naïve diabetic macular edema (DME) and good initial visual acuity (VA).

Methods : Retrospective cohort study following the long-term natural history of eyes with untreated center-involving DME and baseline VA ≥ 20/25 seen at the University of California, Davis Eye Center between March 2007 to March 2018. We collected clinical characteristics including diabetes type, hemoglobin A1c, presence of visual symptoms, VA, and diabetic retinopathy (DR) severity; and spectral domain-optical coherence tomography (SD-OCT) biomarkers including central subfield thickness, intraretinal cyst size, intraretinal hyperreflective foci, disorganization of the retinal inner layers (DRIL), and outer retinal layer disruptions, to determine factors associated with vision loss as defined by the DRCR Protocol V study as the threshold for initiating aflibercept therapy.

Results : 76 eyes (67 patients) with untreated DME and mean baseline VA of logMAR 0.05 ± 0.05 (Snellen 20/22) was followed for an average of 4.3 ± 3.2 years, with a median time to vision loss of 335.5 days (11 months). Older age (hazard ratio (HR) 1.027/year, P = 0.04) and eyes with severe non-proliferative DR (HR 2.42, P = 0.01) or proliferative DR (HR 3.79, P < 0.001) showed a higher risk of vision loss, while no SD-OCT biomarker showed a significant association.

Conclusions : In eyes with DME and good initial vision, older patients or those with worse DR severity should be monitored more closely for prompt treatment initiation when vision loss occurs.

This is a 2021 ARVO Annual Meeting abstract.