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October 14, 2021
2 minutes to read
Source / Disclosures
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Disclosures: Lent-Schochet does not report any relevant financial information. Please see the study for relevant financial information from all other authors.
Older age and more severe diabetic retinopathy were linked to vision loss in eyes with diabetic macular edema and good initial visual acuity, according to a retrospective cohort study conducted in Retina.
“Although some real-world studies suggest that anti-vascular endothelial growth factor therapy for DME with good visual acuity [does] no improvement in visual results after 1.7 years of follow-up, treatment delayed in these types of patients after a median follow-up of 3 years [was] linked to poor visual results, with poorer visual acuity at the time of initiation of treatment associated with poorer long-term visual results â€, Daniella Lent-Schochet, BS, of the Department of Ophthalmology and Vision Sciences, University of California Davis and California Northstate University College of Medicine, and colleagues have written. “These studies highlight the importance of close monitoring and the value of identifying factors that can predict the risk of vision loss when observing patients with DME and good initial visual acuity.”
Lent-Schochet and his colleagues set out to determine which factors are most important to watch out for in these patients. Demographic and clinical characteristics were recorded, with vision loss defined by the DRCR Protocol V study. The study included 56 eyes of 48 patients (mean age, 63.1 years) with DME involving the center, seen at the Davis Eye Center at the University of California between March 8, 2007 and March 8, 2018.
The inclusion criteria were visual acuity of at least 20/25 at baseline, no previous DME treatment, at least 1 year follow-up with OCT spectral domain imaging, and no treatment of any kind in the eye of the patient. study during the study period.
During an average follow-up period of 4.9 years, 42 eyes (75%) experienced loss of visual acuity, which mainly occurred in men (70.8%) and people with type 2 diabetes (89.6%).
Visual acuity decreased from logMAR 0.05 ± 0.05 at baseline to logMAR 0.125 ± 0.194 at 1 year, logMAR 0.209 ± 0.165 at 2 years, logMAR 0.234 ± 0.201 at 3 years and logMAR 0.260 ± 0.207 at 4 years. The median time to vision loss was 442 days for the 42 eyes with vision loss.
Vision loss was associated with advanced age (P = .075) and higher HbA1c (P = .031); eyes with severe nonproliferative diabetic retinopathy (NPDR) (P = .020) and non-high risk or inactive PDR (P = 0.025) had a higher risk of vision loss than people with mild or moderate NPDR.
Among the SD-OCT biomarkers evaluated, only the thickness of the central subfield (P = .0470) and the diameter of the cyst (P = .0094) were associated with vision loss.
“In summary, we found that older age and more severe DR were associated with a risk of vision loss in eyes with DME and good initial visual acuity. Outside of the context of strict adherence to Protocol V, these characteristics are important factors in deciding the optimal frequency of follow-up visits, â€wrote the study authors.
Perspective
Carolyn E. Majcher, DO, FAAO
It is important for eye care providers to know which eyes with DME are likely to be treated and which are most at risk for vision loss and require closer monitoring.
There remains a debate on the best management strategy for the eyes with a central DME (CI-DME) and good vision. The 2-year results of the DRCR Network Protocol V baseline study showed that there was no significant visual benefit from treating eyes with CI-DME and ETDRS acuity of 20/25 or better immediately with Intravitreal aflibercept versus withholding injections until acuity worsens. The authors therefore concluded that the latter may be a reasonable management strategy for treatment-naïve eyes with CI-DME and good vision. But how does this strategy behave in real settings where follow-up may be less frequent, and can we predict which patients will experience vision loss?
This study by Lent-Schochet and colleagues found that among patients with untreated CI-DME and good vision, those with severe or worse NPDR and those older had the greatest risk of vision loss. In fact, eyes with severe NPDR were three times more likely to lose vision (the median time to vision loss was approximately 11 months) and required anti-VEGF treatment compared to eyes with disease. at a lighter stage.
First and foremost, this study highlights the importance of screening all eyes with retinopathy, regardless of acuity, for DME using OCT. Eyes with excellent acuity may still have a CI-DME which may lend itself to early anti-VEGF treatment, especially if coexisting risk factors are present. In eyes with severe stage CI-DME and NPDR, anti-VEGF treatment may not only benefit the EMR, but also stabilize or improve the stage of retinopathy and reduce the risk of developing vision-threatening complications. .
Carolyn E. Majcher, DO, FAAO
Associate Professor, Oklahoma College of Optometry, Northeastern State University
Disclosures: Majcher reports consulting and speaking for Carl Zeiss Meditec and receiving research papers from Nidek and Diopsys.
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