No rush to treat diabetic macular edema with good visual acuity
medwireNews: Research published in JAMA shows similar outcomes for patients with center-involved diabetic macular edema (DME) and good visual acuity over the first 2 years after diagnosis, regardless of whether they are managed with aflibercept, laser photocoagulation, or observation.
The 702 adults included in the randomized trial were aged an average of 59 years, and had either type 1 or type 2 diabetes and DME involving the center of the macula, but had good visual acuity, with best-corrected vision of 20/25 or better in their affected eye.
The author of a linked editorial, Emily Chew (National Eye Institute, Bethesda, Maryland, USA), notes that “there are limited data on the management of such eyes, and a large proportion of patients who present clinically with diabetic macular edema have good visual acuity.”
During 2 years of follow-up, visual acuity declined by at least five letters in 16% of patients randomly assigned to receive aflibercept injections (at baseline and every 4 weeks as needed), in 17% of those treated with laser photocoagulation, and in 19% of those whose eyes were monitored and treated with aflibercept only if visual acuity declined by 10 letters or more.
There were no significant differences between the groups for this primary outcome, nor for most secondary outcomes, except for a higher percentage of eyes with visual acuity of 20/20 or better at 2 years in the aflibercept versus observation groups, at 77% versus 66% (down from 80 vs 78% at baseline).
The mean changes in visual acuity letter score did not significantly differ between groups, at 0.9 and 0.1 increases with aflibercept and laser photocoagulation, respectively, and a 0.4 decline with observation, report Adam Glassman (Jaeb Center for Health Research, Tampa, Florida, USA) and study co-authors.
In her editorial, Chew notes that delaying aflibercept therapy will reduce healthcare costs, but stresses that “[i]t is the patient who has the most to gain from these study results.”
She says: “Some patients may not need intraocular injections of anti-VEGF [vascular endothelial growth factor] therapies, which carry a risk, albeit small, of endophthalmitis.”
Chew concludes: “This approach could not only reduce the increased economic burden associated with intraocular injection therapy, but also could reduce the demands and psychological burden of treatment for diabetic retinopathy for the patients, their families, and society.”
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