Practice Patterns and Outcomes in Patients with Nonproliferative Diabetic Retinopathy without Diabetic Macular Edema

Abstract

Purpose : In eyes with moderate to severe nonproliferative diabetic retinopathy (NPDR), the PANORAMA and DRCR Protocol W clinical trials demonstrated improvement in diabetic retinopathy severity scores and reduction in vision threatening complications (VTC; defined as proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME)) with prophylactic anti-vascular endothelial growth factor intravitreal injections (IVI). Given limited analyses of management approaches from routine clinical practice, our study aims to analyze clinical practice patterns and outcomes among patients with NPDR without DME.

Methods : Retrospectively reviewed patients newly diagnosed with NPDR without DME or other retinal pathology between January 1, 2018 to December 31, 2022 at a large urban retina practice (19 physicians). Visual acuity (VA), VTC, and treatment data were collected every 6 months. Interim analysis was performed using student’s t-test.

Results : 478 eyes from 319 subjects met inclusion criteria. Baseline VA among all eyes was 0.20±0.20 logMAR. Of 21 eyes (4.4%) treated, 5 eyes (1.0%) were treated prophylactically at baseline and 16 eyes (3.3%) were treated after VTC development. All treatments were IVI except for one focal laser. Over a mean follow-up time of 91.9±73.0 weeks, 40 eyes (10.3%) developed a VTC. 30 eyes developed DME only (3 received prophylactic IVI, 4 received IVI after DME onset). 3 eyes developed PDR without DME and 7 developed PDR with DME (all treated with IVI). Of the 5 eyes treated prophylactically, 2 remained stable. There was no significant difference in mean time to VTC development among eyes treated prophylactically (25.3±4.0 weeks) and those initiating treatment at VTC onset (52.0±37.8 weeks, p=0.25). Among the 3 eyes treated prophylactically that developed a VTC, 2 had worsened VA at the final visit and 1 had improved VA. Among eyes treated after VTC onset, 6 eyes (40.0%) worsened, 7 eyes (46.7%) improved, and 3 eyes (20.0%) remained stable.

Conclusions : In this large practice, prophylactic treatment of NPDR without DME was limited. Prophylaxis provided no benefit in VA or time to VTC onset, though no eye treated prophylactically developed PDR, which may impact longer-term outcomes. These findings reaffirm PANORAMA and Protocol W results that suggest early treatment of NPDR without DME may provide anatomic rather than visual benefit through 2-year follow-up.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.