Anne C Biechl1, Sanjeeb Bhandari2, Vuong Nguyen2, Jennifer J Arnold3, Stephanie Young4, Samantha Fraser-Bell2, Hemal Mehta2,5, Mark Gillies2, Daniel Barthelmes1,2. 1. Department of Ophthalmology, University of Zurich, Zurich, Switzerland. 2. Sydney Medical School, Discipline of Ophthalmology and Eye Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia. 3. Marsden Eye Specialists, Parramatta, New South Wales, Australia. 4. Gladesville Eye Specialists, Gladesville, New South Wales, Australia. 5. Ophthalmology Department, Royal Free London NHS Foundation Trust, London, UK.
Abstract
IMPORTANCE: Evaluating the treatment outcomes of diabetic macular oedema (DMO) in routine clinical practice provides data for comparison with those of clinical trials. BACKGROUND: Phase 3 clinical trials of vascular endothelial growth factor (VEGF) inhibitors for DMO have reported significant improvements in visual acuity (VA) not previously reported with laser and steroid treatments. DESIGN: Retrospective analysis of observational data from routine clinical practice. PARTICIPANTS: Eyes receiving treatments for DMO tracked in the Fight Retinal Blindness! Registry. METHODS: We analysed 510 eyes (347 patients) that started DMO treatment between 2009 and 2014. MAIN OUTCOME MEASURES: Changes in DMO treatment patterns and mean change in VA (letters logMAR) and central subfield thickness (CST) 5 years after starting treatment. RESULTS: Treatment choice for DMO changed to predominantly VEGF inhibitors from 2009 to 2014. A total of 238 eyes (47%) were followed for at least 5 years. The mean VA at the start of treatment improved from 2009 (58 letters) to 2014 (68 letters) while mean VA change at 5 years were + 4.5 and + 5.3 letters for eyes starting treatment in 2009 and 2014, respectively. The mean CST dropped from 401 μm at baseline to 314 μm at 5 years. Eyes received a median of four injections in the first, two in the second, third and fourth and three in the fifth years. CONCLUSIONS AND RELEVANCE: Changing the treatment of DMO from macular laser and intravitreal triamcinolone to VEGF inhibitors from 2011 onwards was associated with better VA outcomes, part of which were due to better VA at the start of treatment. The outcomes of treatment in eyes in real-world practice were, however, worse than those reported by clinical trials, likely because they were undertreated.
IMPORTANCE: Evaluating the treatment outcomes of diabetic macular oedema (DMO) in routine clinical practice provides data for comparison with those of clinical trials. BACKGROUND: Phase 3 clinical trials of vascular endothelial growth factor (VEGF) inhibitors for DMO have reported significant improvements in visual acuity (VA) not previously reported with laser and steroid treatments. DESIGN: Retrospective analysis of observational data from routine clinical practice. PARTICIPANTS: Eyes receiving treatments for DMO tracked in the Fight Retinal Blindness! Registry. METHODS: We analysed 510 eyes (347 patients) that started DMO treatment between 2009 and 2014. MAIN OUTCOME MEASURES: Changes in DMO treatment patterns and mean change in VA (letters logMAR) and central subfield thickness (CST) 5 years after starting treatment. RESULTS: Treatment choice for DMO changed to predominantly VEGF inhibitors from 2009 to 2014. A total of 238 eyes (47%) were followed for at least 5 years. The mean VA at the start of treatment improved from 2009 (58 letters) to 2014 (68 letters) while mean VA change at 5 years were + 4.5 and + 5.3 letters for eyes starting treatment in 2009 and 2014, respectively. The mean CST dropped from 401 μm at baseline to 314 μm at 5 years. Eyes received a median of four injections in the first, two in the second, third and fourth and three in the fifth years. CONCLUSIONS AND RELEVANCE: Changing the treatment of DMO from macular laser and intravitreal triamcinolone to VEGF inhibitors from 2011 onwards was associated with better VA outcomes, part of which were due to better VA at the start of treatment. The outcomes of treatment in eyes in real-world practice were, however, worse than those reported by clinical trials, likely because they were undertreated.
Authors: Sanjeeb Bhandari; Vuong Nguyen; Adrian Hunt; Pierre-Henry Gabrielle; Francesco Viola; Hemal Mehta; Les Manning; David Squirrell; Jennifer Arnold; Ian L McAllister; Daniel Barthelmes; Mark Gillies Journal: Eye (Lond) Date: 2022-05-04 Impact factor: 4.456