Abstract
Purpose :
To understand the relationship between baseline best-corrected visual acuity (BCVA) and visual outcomes and vision-related functions in patients with diabetic macular edema (DME).
Methods :
This pooled post hoc analysis of VISTA and VIVID trials included eyes treated with intravitreal aflibercept (IAI) 2 mg either every 4 weeks (2q4; n=289) or every 8 weeks (2q8; n=283) after 5 initial monthly doses. Eyes were categorized by baseline BCVA: ≥25 to ≤54 (group [G] 1), ≥55 to ≤69 (G2), or ≥70 to ≤74 (G3) letters. Change in BCVA, proportion with BCVA ≥70 letters, and Visual Function Questionnaire 25 (VFQ-25) total and subscale scores were analyzed. The Cochran-Mantel-Haenszel method was used to compare groups for binary outcomes and analysis of covariance for continuous outcomes.
Results :
At Week 100, mean BCVA gains from baseline in G1, G2, and G3 were, respectively, 19.4, 11.6, and 11.1 letters with IAI 2q4, and 16.0, 11.5, and 9.3 letters with IAI 2q8. The respective proportions of eyes in G1, G2, and G3 with BCVA ≥70 letters were 30.0%, 60.9%, and 56.0% with IAI 2q4, and 47.4%, 74.5%, and 73.2% with IAI 2q8 at Week 100 (P<0.0001 for G2 or G3 vs G1 in both treatment groups). In both treatment groups, patients with better baseline BCVA had greater VFQ-25 total scores at Week 100 (differences between means for G2 and G3, respectively, vs G1: 6.7 and 11.3 [IAI 2q4], 5.1 and 12.6 [IAI 2q8]; all P<0.05). Similar trends were seen for VFQ-25 subscale scores of General Vision, Near Activities, Distance Activities, Social Functioning, Mental Health, Role Difficulties, Dependency, and Driving (range of differences between means for G3 vs G1 across subscales: 8.7–21.3 [IAI 2q4] and 8.5–20.3 [IAI 2q8]; all P<0.05), with the largest difference in both treatment groups observed for the Driving subscale.
Conclusions :
Eyes with DME and worse baseline BCVA gained more letters compared with eyes with better baseline BCVA. However, a significantly greater proportion of patients with better baseline vision had BCVA ≥70 letters and better VFQ-25 scores at Week 100.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.