Diabetic macular edema 5-year outcomes: a multicenter analysis

Abstract

Purpose : Diabetes prevalence has risen in recent decades. Diabetic macular edema (DME) is a major contributor to vision loss. This analysis assessed treatments and visual acuity (VA) of treatment-naïve DME eyes, mostly referred from diabetic eye screening programs, at four National Health Service centers in the United Kingdom.

Methods : Data from 2008-2021 were extracted from the Medisoft electronic health record. One treatment-naïve eye per adult DME patient was included (if bilateral, first eye to meet case definition, or right eye if both met definition simultaneously). Eyes with <180 days of follow-up after index diagnosis, neovascular age-related macular degeneration, or retinal vein occlusion were excluded. Treatment patterns and VA outcomes were described up to 5 years from index diagnosis.

Results : The cohort (n=8,713), followed for a median of 3 years, had a median age of 61 years, and was 40% women and 68% white. After diagnosis, 50% of DME patients received no treatment, 24% received anti-vascular endothelial growth factor (VEGF) only, 16% received macular laser only, and the others were treated with combinations/other treatments. Anti-VEGF injections represent 76% of the total number of treatments (33,467). Median VA change 5 years after diagnosis (median baseline VA) in letters (n=976) was 0 (70) for anti-VEGF treated eyes, -2 (75) for untreated eyes, and 0 (75) for eyes receiving other treatments. Among patients treated with anti-VEGF, median (interquartile range [IQR]) VA before index treatment was 64 (52-72) letters, and median (IQR) days from diagnosis to treatment was 24 (0-410) days.

Conclusions : Median baseline VA was high for this DME cohort. On average, DME patients had minimal vision change over time. However, among patients who were eventually treated with anti-VEGF, median VA before treatment was lower than median baseline VA, and a quarter of patients received anti-VEGF treatment >1 year after diagnosis. This suggests a benefit for patients to be continually monitored for disease activity to provide timely treatment if necessary. DME monitoring visits and anti-VEGF treatments contribute to healthcare system and patient burden. This burden will likely increase with the rise of diabetes prevalence. More durable therapies and more convenient disease monitoring may help to alleviate the burden of disease.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Fig 1. Treatments received after DME diagnosis

 

Fig 2. Baseline and VA change over time by treatment