Abstract
Intravitreal anti-VEGF injections are the current gold standard for treating diabetic macular edema (DME). However, injection practice patterns of retina specialists have varied markedly based on physician discretion. This retrospective study analyzes the impact of injection protocol selection on change in best-corrected visual acuity (BCVA) and central macular thickness (CMT) in 170 eyes treated by 4 retina specialists practicing a pro re nata (PRN) strategy between 2010 and 2020. DME patients received an average of 7.25 injections every 6.24 weeks over 56.6 weeks. There were significant differences between retina specialists in mean number of injections (p = 0.0001) and mean length of treatment (p = 0.0007) but not in mean interval between injections. Over the treatment period, average change in BCVA was −0.053 logMAR, and average change in CMT was −51.1 µm, neither of which had significant differences between retina specialists. BCVA and CMT at initial visit were found to be significantly associated with improved BCVA and CMT over the treatment period (p < 0.001). Number of injections administered and interval between injections were not found to be significant factors affecting change in BCVA or CMT. Despite significant differences in injection dosing regimen, retina specialists achieved similar outcomes in change in BCVA and CMT over the treatment period.
Highlights
Diabetes mellitus (DM) currently affects 463 million adults worldwide, with an expected rise to 700 million by the year 2045 [1]
Four retina specialists were excluded because they had fewer than five diabetic macular edema (DME) patients over the time frame, which subsequently resulted in the exclusion of 2 additional patients from the study
A total of 170 eyes from 122 DME patients between 4 retina specialists labeled as A, B, C, and D were included in the data analysis
Summary
Diabetes mellitus (DM) currently affects 463 million adults worldwide, with an expected rise to 700 million by the year 2045 [1]. Ranibizumab and aflibercept are both FDA approved while bevacizumab is used off-label for treatment of DME Despite these differences, the three anti-VEGF therapies have demonstrated similar efficacy on reduction of retinal thickness and improvement of visual acuity in DME patients with mild vision loss [10]. Another study indicated that T&E strategies lead to high patient adherence and visual acuity gains [15] Both studies reveal that there is a need to standardize intravitreal injection protocols among retina specialists to reduce patient and physician burden. Multiple studies have analyzed the effects of differences in anti-VEGF drugs on clinical outcomes, the impact of specific injection protocol selection of individual retina specialists has not been studied [9,10,19,20,21,22,23]. The two main outcomes assessed were improvement in best corrected visual acuity (BCVA) and decrease in central macular thickness (CMT) which are clinical markers used to assess progression of DME
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