Early treatment with anti-VEGF injections reduces diabetic retinopathy complications

In this study, participants with NPDR were randomly assigned at baseline to receive either injections of Eylea (aflibercept) or a sham injection. They were examined at one, two, and four months, and then every four months for two years, receiving Eylea or sham injection at each visit. The researchers tracked their visual acuity and the severity of their diabetic retinopathy. If disease progressed, regardless of whether they were in the treatment or sham group, participants were given Eylea more frequently as is given in standard practice. If their condition did not improve with additional anti-VEGF treatment, participants could be given treatments such as laser photocoagulation or surgery if necessary.

The study included 328 participants (399 eyes). In two years, the rate of PDR development was 33% in the control group, compared with 14% in the treatment group. Likewise, the rate of development of DME affecting vision was 15% in the control group, compared with 4% in the treatment group. However, loss of visual acuity was essentially the same between the two groups at 2 years, suggesting that standard treatment at the appearance of PDR or DME affecting vision is sufficient to prevent further vision loss at this time point.

"We have a really good treatment for these diseases, so we can manage vision complications that may arise as disease progresses for many eyes," said Adam Glassman, Jaeb Center for Health Research, director of the DRCR.net coordinating center. "When evaluating new preventative treatment strategies, it is important to compare them directly to the standard treatment after disease worsens, as we have done in this study."

"Although we did not see any difference in visual outcomes at two years, the four-year follow-up is going to be very important," said Jennifer Sun, M.D., M.P.H., Joslin Diabetes Center, Harvard Medical School, chair of Diabetes Initiatives for the Network. "We look toward the four-year data to see whether reducing rates of diabetic retinopathy worsening will lead to long-term improvement in visual outcomes."