Abstract
Purpose :
Diabetic macular edema (DME) is a major cause of vision loss which, if left untreated, can lead to blindness. While smoking is linked with a higher incidence of diabetic macular edema and with decreased macular vessel length density on OCTA, the impact of smoking on response to anti-VEGF treatment remains understudied. The purpose herein was to examine the effect of smoking status on vision and macula edema resolution on OCT with anti-VEGF therapy.
Methods :
833 eyes from 703 patients with DME receiving anti-VEGF injections between Jan 2015 and Dec 2022 at the Wilmer Eye Institute were analyzed. Patients were categorized as Never- (NS), Former- (FS), and Current-smokers (CS), and pack-year data were collected. Visual acuity (LogMAR), number of injections, and OCT parameters of central retinal thickness (CRT), and presence/change in intraretinal or subretinal fluid (IRF, SRF) were measured at baseline, and at 1 and 6 months during anti-VEGF therapy.
Results :
Of 833 eyes, 467 were NS, 301 were FS, and 65 were CS. CS had a 14.91±22.72 pack-year history while FS had 4.07±8.88 pack-years. Bevacizumab was used more often than aflibercept in NS and FS compared to CS (72% vs. 82% vs. 68%, p=0.013). At baseline, visual acuity, and IRF or SRF did not differ among groups, but CRT (300±118 vs. 277±115 vs. 309±136µm, NS/FS/CS, p=0.022) did (Table 1). While a decrease in SRF occurred in more FS than NS and CS at month 1 (42% vs. 31% and 31%, p=0.034), a greater proportion of FS and NS showed a decrease in SRF than CS at month 6 (30% and 26% vs. 16%, p=0.044). The number of injections and logMAR visual acuity with treatment did not differ among groups.
Conclusions :
Using SRF on OCT as a biomarker of treatment response, CS had less response after 6 months of treatment. This response did not affect visual outcomes. Further study on the impact of smoking on response to anti-VEGF treatment in DME is warranted.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.