45-OR: Less Favorable Response to Anti-VEGF Therapy in Patients with Diabetic Macular Edema and Decreased Baseline Outer Retinal Layer Thickness

Abstract

Early identification of patients who are more likely to respond to anti-VEGF therapy for diabetic macular edema (DME) would improve patient management and allow for more rapid assessment of new therapeutic targets. This study evaluated retinal thickness variables and their association with anti-VEGF therapy response in patients with DME. We identified patients at the Joslin Diabetes Center who received their first anti-VEGF injection for DME between 1/2016-12/20 and assessed mean change in visual acuity (VA) and central retinal thickness (RT) at 6 mos. A good VA or RT response to anti-VEGF therapy was defined using thresholds of letter and retinal thickness change as follows: eyes with baseline VA of ≥20/32, ≥5 letters; 20/40-20/70, ≥letters; ≤20/80, ≥15 letters and eyes with baseline RT of <375µm, >10%; 375-449µm, >20%; >449µm, >25%. A total of 151 eyes from 126 patients fell into the following responder groups: both VA and RT response (32.5%) , only VA response (21.9%) or RT response (11.3%) , and neither VA nor RT response (34.4%) , with 57.0% of all eyes exhibiting VA response and 43.7% exhibiting RT response. While diabetes duration, A1c, and blood pressure were not associated with responder group, decreased baseline thickness of the outer retinal layer (ORL) was more likely to be present in eyes with neither VA nor RT response (β=-.018; 95% CI -0.03 to -0.01; P=.006) . Improvement in mean VA was associated with younger age (β=.004; 95% CI 0.001-0.007; P=.01) . Decreased baseline ORL thickness (β=-.003; 95% CI -0.0to -0.001; P=.01) and increased baseline inner retinal layer (IRL) thickness (β=.0004; 95% CI 0.0001-0.0007; P=.02) were associated with less VA gain at 6 mos. These findings suggest that decreased baseline ORL thickness is associated with less favorable outcome after anti-VEGF therapy and may be a potential biomarker for treatment response in patients with DME. Disclosure M.G.Mitzner: None. W.Fickweiler: None. D.B.Robinson: None. T.Boumenna: None. L.P.Aiello: Consultant; KalVista Pharmaceuticals, Inc., Novo Nordisk, Stock/Shareholder; KalVista Pharmaceuticals, Inc. J.Sun: Consultant; American Diabetes Association, American Medical Association, Research Support; Adaptive Sensory Technology, Boehringer Ingelheim International GmbH, Genentech, Inc., Jaeb Center for Health Research, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Optovue, Incorporated, Physical Sciences, Inc, Roche Pharmaceuticals. Funding American Diabetes Association (7-21-PDF-022) ; National Eye Institute (R01EYE26080-01) ; National Institute of Diabetes and Digestive and Kidney Diseases and National Institutes of Health (DP3-DK-094333-01) ; JDRF (17-2013-310) ; The Dianne Nunnally Hoppes Fund; The Beatson Pledge Fund