Abstract
Purpose :
While first line treatment for diabetic macular edema (DME) is anti-vascular endothelial growth factor (VEGF) therapy, many patients experience lapses in treatment. Less is known about the visual outcomes following lapses in treatment. The purpose of this study is to identify baseline factors that predict visual response after a treatment lapse of anti-VEGF for eyes with DME.
Methods :
This is a retrospective analysis of patients with DME who underwent a lapse of anti-VEGF treatment for at least three months. 262 patients were separated into groups of “stable vision” (n=201) and “vision loss” (n=61), defined as loss of at least 10 letters on ETDRS testing. The two groups were compared across several baseline past medical and ophthalmic history factors to identify those associated with vision loss. Step-wise backward logistic regression was used to create a simplified prediction algorithm and identify factors associated with higher odds of losing vision.
Results :
The average lapse length was greater in the “vision loss” group than in the “stable vision group” (9.2±9.5 vs 5.8±3.4 months, p<0.001). The groups also differed significantly in their distribution across insurance types (p<0.05) (Table 1). Age, insurance type, history of diabetic foot disease, diabetic medications, lapse length, time since diabetic retinopathy (DR) diagnosis, and total injections prior to lapse were included in the simplified regression model. The use of diabetic medications and time since DR diagnosis significantly reduced the odds of vision loss, while lapse length, total injections, and foot disease significantly increased the odds of losing vision (p<0.05) (Table 1). The final model had a sensitivity of 13% and specificity of 87%, with 65.3% area under the curve (Table 2).
Conclusions :
Patients with history of diabetic foot disease, more injections, and longer lapses in treatment are at higher risk for vision loss after a lapse in treatment for DME. Providers should consider these factors when creating a collaborative treatment and follow-up plan.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.