Perspective from Carolyn E. Majcher, OD, FAAO
Disclosures: Lent-Schochet reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 14, 2021
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Older age, worse diabetic retinopathy may predict vision loss in DME

Perspective from Carolyn E. Majcher, OD, FAAO
Disclosures: Lent-Schochet reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Older age and more severe diabetic retinopathy were linked to vision loss in eyes with diabetic macular edema and good starting visual acuity, according to a retrospective cohort study in Retina.

“Although some real-world studies suggest that anti-vascular endothelial growth factor therapy for DME with good visual acuity [does] not improve visual outcomes after 1.7 years of follow-up, delayed treatment in these types of patients after a median follow-up of 3 years [was] linked to poor visual outcomes, with worse visual acuity at the time of treatment initiation associated with poorer long-term visual outcomes,” Daniella Lent-Schochet, BS, of the department of ophthalmology and vision science, University of California Davis, and California Northstate University College of Medicine, and colleagues wrote. “These studies highlight the importance of close monitoring and the value of identifying factors that may predict the risk of vision loss when observing patients with DME and good initial visual acuity.”

Lent-Schochet and colleagues set out to determine what factors are most important to monitor 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 center-involving DME seen at University of California Davis Eye Center between March 8, 2007, and March 8, 2018.

Inclusion criteria were visual acuity of at least 20/25 at baseline, no prior DME treatment, at least 1 year of follow-up with spectral-domain OCT imaging and no treatment of any kind in the study eye during the study period.

During an average follow-up period of 4.9 years, 42 eyes (75%) had visual acuity loss, which occurred mainly in men (70.8%) and people with type 2 diabetes (89.6%).

Visual acuity declined 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. Median time to vision loss was 442 days in the 42 eyes that had vision loss.

Vision loss was associated with older 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 = .025) were at higher risk for vision loss than those with mild or moderate NPDR.

Among SD-OCT biomarkers evaluated, only central subfield thickness (P = .0470) and cyst diameter (P = .0094) were associated with vision loss.

“In summary, we found that older age and worse DR severity were associated with risk of vision loss in eyes with DME and good initial visual acuity. Outside of the context of strict adherence to the Protocol V regimen, these features are important factors when deciding on the optimal frequency of follow-up visits,” the study authors wrote.