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Persistent DME after anti-VEGF therapy may yield poor long-term vision improvement
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BALTIMORE — An increased duration of diabetic macular edema in the first 6 months after treatment with an anti-VEGF agent may be associated with worse long-term vision improvement, according to research presented here.
“There’s been a debate for a long time on the correlation between retinal edema and long-term visual acuity,” Scott M. Whitcup, MD, said in an interview with Healio.com/OSN at the Association for Research in Vision and Ophthalmology annual meeting.
“Do wetter retinas lose vision? A lot of the current studies have shown variable correlations between edema and vision,” he said. “Part of the reason is that people look at a snapshot, and I think a better way to look at it is edema over time and vision over time.”
The post hoc analysis of the DRCR.net Protocol I consisted of 367 eyes of DME patients randomized to Lucentis (ranibizumab, Genentech) and prompt or deferred laser. The eyes were divided into four cohorts based on duration of edema.
By week 24, patients had completed seven visits. Central retinal thickness was 250 µm of greater in one visit or less (cohort 1) in 56 eyes (15.3%), two to three visits (cohort 2) in 90 eyes (24.5%), four to five visits (cohort 3) in 57 eyes (15.5%) and six or more visits (cohort 4) in 164 eyes (44.7%).
In cohort 4, 65.9% of eyes had six or more visits with central retinal thickness of 250 µm or greater over the next 24 weeks of treatment.
Cohort 4 eyes gained an average of 3.8 fewer letters compared with cohort 1 eyes over the first 156 weeks, after adjusting for potential confounders (P = .012).
There was a statistically significant association between duration of edema at week 24 and decreased average vision improvement at week 156.
“We found that people who are going to have wetter retinas and drier retinas in response to anti-VEGFs are different at baseline, and you have to correct those differences to see the appropriate correlation,” Whitcup said.
After correcting for baseline differences in these patients, Whitcup suggests that wet retinas do lose more vision over time, at just more than 5 letters at 3 years. – by Abigail Sutton
Reference:
Whitcup SM, et al. Persistent diabetic macular edema after 6 months of anti-VEGF therapy is associated with diminished long-term improvement in vision: a post-hoc analysis of Protocol I. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 7-11, 2017; Baltimore.
Disclosure: Whitcup reports he is a consultant for Allergan. Please see the study for all other authors’ relevant financial disclosures.