Older age, worsened diabetic retinopathy may predict vision loss in DME

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October 14, 2021

2 minutes to read

Disclosures: Lent-Schochet does not report any relevant financial information. Please see the study for relevant financial information from all other authors.


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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 ”, 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, ”wrote the study authors.


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