WEDNESDAY, March 31, 2021 (HealthDay News) – The overall eye health of people with diabetes benefits from preventative drug injections directly into the eyeball, but it is too early to say whether such treatment will better preserve their long-term vision. test results show.
Regular injections of aflibercept (Eylea) resulted in a more than three-fold reduction in the leakage of blood vessels inside the retina and a more than two-fold reduction in the abnormal growth of blood vessels in the retina, have reported the researchers. The study was supported by the National Eye Institute, part of the US National Institutes of Health, and published on March 30 in JAMA Ophthalmology.
But over two years, patients who received preventative injections of the drug did not perform better on vision tests than others who received treatment only after they started to lose their vision. , showed the results.
“Based on these results, some doctors will choose to treat early because they believe it is important to prevent the development of complications,” said lead investigator Dr Jennifer Sun, head of research and trials eye clinics at the Joslin Diabetes Center at Harvard Medical School in Boston. . “Other doctors will think that even if we prevent complications, if there is no major difference in vision, we might as well hold back and not expose the patient to the cost, burden and risk. processing. “
Diabetic retinopathy is the most common cause of vision loss in people with diabetes. It occurs when blood vessels swell and leak in the retina, the light-sensitive layer at the back of the eye that receives and transmits vision signals to the brain.
Drugs that inhibit the growth of blood vessels – anti-vascular endothelial growth factor (anti-VEGF) drugs – like Eylea are considered the “gold standard” for treating diabetic retinopathy, Sun said.
âBefore these drugs were available, all we actually had was the laser. It was the standard of care for many years. It could certainly slow the progression of the disease, but very often it wasn’t. no improvement, “said Dr. Richard Rosen, a retinal. specialist in the New York Eye and Ear Infirmary of Mount Sinai in New York.
âThese drugs saved vision and allowed people to continue in a more normal way. It really was a huge step forward,â said Rosen, who was not in the study.
But it’s an open question whether people with diabetes would benefit from preventive treatment with anti-VEGF drugs in the early stages of retinopathy, when changes in the blood vessels in the eye are visible to them. doctors but have not yet affected a person’s eyesight.
In this study, 200 eyes with early diabetic retinopathy received regular injections of Eylea, while another 199 eyes were treated with a placebo. The injections were done once a month initially, but eventually went on to once every four months.
If their diabetic retinopathy progressed, people in the placebo group began to receive injections of Eylea to treat their disease.
Over two years, the rate of development of proliferative diabetic retinopathy – the advanced stage of the disease when new blood vessels invade the retina – was 33% in the placebo group and 14% in the treatment group.
The rate of leakage from blood vessels affecting vision was 15% in the placebo group and 4% in the Eylea group.
Vision loss was essentially the same in both groups.
âWhat this study tells us is that over two years, if you don’t treat immediately but treat if complications develop, the visual results on average are still excellent,â Sun said.
The open question is whether preventing these complications in the first place will save vision later. Sun and his colleagues will follow patients for four years to monitor their progress.
Anti-VEGF drugs like Eylea are expensive, between $ 1,000 and $ 2,000 per dose, and patients face rare side effects such as eyeball infections, Sun said. It might not be worth the money or the health risk to provide preventative treatment.
âWhen you talk about a drug that is administered very frequently, it comes at a huge cost to public health,â Sun said.
On the other hand, doctors may be able to preserve patients’ eyesight better if they tackle eye problems head-on.
âThe idea that you can prevent disease progression in patients is very important and makes a lot of sense,â Rosen said. âIt takes many years to develop diabetic retinopathy, but very often there are things that happen to people with this disease that are unplanned and unanticipated. Anything you can do to control the progression of the disease. disease early on makes great clinical sense. “
The National Eye Institute in the United States has more information on diabetic retinopathy.
SOURCES: Jennifer Sun, MD, MPH, ophthalmologist, chief, ocular research and clinical trials, Joslin Diabetes Center, Harvard Medical School, Boston; Richard Rosen, MD, retina specialist, New York Eye and Ear Infirmary of Mount Sinai, New York City; JAMA Ophthalmology, March 30, 2021