Risk of visual acuity loss similar for eyes with diabetic macular edema initially treated vs observed
Australia: The risk of 5-letter visual acuity (VA) loss at 24 months was found to be similar between eyes with the clinically significant diabetic macular edema (DME) and good VA initially treated and eyes initially observed in routine clinical practice, according to a recent study. However, initially observed eyes were at higher risk of developing moderate visual loss, in addition, more than 80% of them needed treatment over 24 months. The study appears in the journal Acta Ophthalmologica.
Pierre-Henry Gabrielle, The University of Sydney, Sydney, New South Wales, Australia, and colleagues conducted the study with an aim to compare VA change at 24 months in eyes with clinically significant DME (CSDME) and good VA initially treated compared to those initially observed in routine clinical practice.
For this purpose, the researchers conducted a retrospective analysis of treatment-naïve eyes with CSDME and good VA (baseline VA ≥ 79 letters) and were followed for at least 24 months and initially managed with treatment (intravitreal treatment and/or macular laser) or observation with possible treatment after 4 months that were tracked in a prospectively designed observational registry.
A total of 150 eligible eyes (98 initially observed, 52 initially treated) of 130 patients.
Based on the study, the researchers found the following:
- The proportion of eyes with at least a 5-letter VA loss at 24 months was not significantly different between the groups: 65% with initial observation and 42% with initial treatment.
- Initially observed eyes were more likely to have a 10-letter VA loss at 24 months (OR = 4.6).
- Most of eyes in the initial observation group received at least one treatment (an intravitreal injection in 66% and macular laser in 20%) during the 24-month period.
Explaining the findings the authors wrote, "Initiating treatment may be a better management option for good vision DME in the case of patients with weak adherence and compliance as it decreases visual loss risk and reduces the management burden of the patient from diabetes and associated comorbidities." "Developing less invasive or more durable treatments may further tilt the balance in favour of initiating treatment earlier."
To conclude, "CSDME eyes with good vision initially managed with treatment versus observation with possible treatment after 4 months had similar rates of 5-letter visual loss over 24 months."
Reference:
Gabrielle PH, Nguyen V, Bhandari S, Mehta H, Viola F, Arnold J, Fraser-Bell S, Barthelmes D, Creuzot-Garcher C, Gillies M. Initial observation or treatment for diabetic macular oedema with good visual acuity: two-year outcomes comparison in routine clinical practice: data from the Fight Retinal Blindness! Registry. Acta Ophthalmol. 2022 May;100(3):285-294. doi: 10.1111/aos.14672. Epub 2020 Nov 16. PMID: 33196150.
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