One-Year Anti-VEGF Therapy Outcomes in Diabetic Macular Edema Based on Treatment Intensity: Data from the Fight Retinal Blindness! Registry.

PURPOSE: To compare 1-year outcomes of eyes with diabetic macular edema (DME) treated in routine clinical practice based on the proportion of visits where intravitreal VEGF inhibitor injections were delivered. DESIGN: Cohort study. PARTICIPANTS: There were 2288 treatment-naive eyes with DME starting intravitreal VEGF inhibitor therapy from October 31, 2015 to October 31, 2021 from the Fight Retinal Blindness! international outcomes registry. METHODS: Eyes were grouped according to the proportion of visits at which an injection was received, Group A with less than the median of 67% (n = 1172) versus Group B with greater than the median (n = 1116). MAIN OUTCOME MEASURES: Mean visual acuity (VA) change after 12 months of treatment. RESULTS: The mean (95% confidence interval [CI]) VA change after 12 months of treatment was 3.6 (2.8-4.4) letters for eyes in Group A versus 5.2 (4.4-5.9) letters for eyes in Group B (P = 0.005). The mean (95% CI) central subfield thickness (CST) change was -69 (-76 to -61) µm and -85 (-92 to -78) µm for eyes in Group A versus Group B, respectively (P = 0.002). A moderate positive correlation was observed between the number of injections received over 12 months of treatment and the change in VA (P < 0.001). Additionally, eyes that received more injections had a moderately greater CST reduction. CONCLUSIONS: This registry analysis found that overall VA and anatomic outcomes tended to be better in DME eyes treated at a greater proportion of visits in the first year of intravitreal VEGF inhibitor therapy. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Real-World Investigation of Impact of Retinal Fluid in Treatment Naïve Eyes Treated with Anti-VEGF for Neovascular Age-Related Macular Degeneration.

BACKGROUND: Traditionally, visual acuity gain and central retinal thickness have been used to measure outcomes when investigating the efficacy of vascular endothelial growth factor (VEGF) inhibitors for patients with neovascular age-related macular degeneration (nARMD). However, localization of retinal fluid may offer additional prognostic value for treatment. The primary aim of this retrospective clinical audit was to investigate whether the presence and location of subretinal fluid has an effect on the visual outcomes of treatment naïve patients with nARMD treated in the real-world setting with VEGF inhibitors. Secondary aims included investigation of change to visual and anatomical outcomes and investigation of the dosing schedule. METHODS: Retrospective observational study of patients attending one suburban and one regional ophthalmology clinic requiring treatment with VEGF inhibitors for nARMD using single-user non-identifiable data from the Fight Retinal Blindness! Registry from 2014 to 2020. Visual acuity (VA) and central subfield thickness (CST) were recorded at baseline, 3, 6, 12 and 24 months. RESULTS: Forty-nine eyes of 42 treatment naïve patients were included for analysis (aged 62-89 years). Almost half (49%) presented with a combination of intra- and subretinal fluid at baseline. Intraretinal fluid was present in 75% of eyes but decreased to 22.7% of eyes by 24 months. VA at baseline was 55 letters, and this improved by 6 letters. The change in VA from baseline to 3, 6 and 12 months was statistically significant (p < .05). The mean change in CST from baseline to 3 months was significant (-76 µm). This change was also observed at the other milestones (p < .001). CONCLUSIONS: The findings of this study suggest that allowing some subretinal fluid to remain will not affect treatment outcomes.

Incidence and progression of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 2.

BACKGROUND: The Katherine Region Diabetic retinopathy Study (KRDRS) was carried out in the Lower Top End of the Northern Territory of Australia between 1993 and 1996 as part of the Northern Territory Eye Health Program. It investigated diabetic eye conditions and their determinants in the Australian Aboriginal population of the region. METHODS: The KRDRS was comprised of two cross-sectional surveys, in 1993 and in 1996, and involved a total of 477 subjects with diabetes. Ninety-six subjects were seen in both surveys and met the criteria for inclusion in the longitudinal study. Each subject underwent a general eye examination and retinal photography. RESULTS: The annual incidence rates of retinopathy were 5.6% (95% CI 3.0-10.0%) and 4.2% (95% CI 2.5-7.0%) in subjects and eyes, respectively. This compares with 8% (in subjects) of the overall Australian diabetic population found in the Newcastle Study of Diabetic Retinopathy. However, each year 1.2% of subjects (95% CI 0.2-3.8%) and 1.3% of eyes (95% CI 0.2-4.5%) with no pre-existing retinopathy developed vision-threatening retinopathy. The respective findings for maculopathy were 2.2% (95% CI 0.7-4.6%) and 1.7% (95% CI 0.7-3.2%), and for clinically significant macula oedema (CSME) 1.1% (95% CI 0.2-3.1%) and 0.9% (95% CI 0.3-2.2%). The annual incidence of CSME in those with no maculopathy when first seen was 1.1% (95% CI 0.2-3.3%) and 0.9% (95% CI 0.3-2.2%) in subjects and eyes, respectively. The annual progression to CSME in those with maculopathy was 4.8% (95% CI 0.1-26.5%) and 6.1% (0.7-21.9%) in subjects and eyes, respectively. CONCLUSION: Results of the KRDRS show that despite a lower overall incidence of diabetic retinopathy among Aboriginal diabetics compared to the general Australian diabetic population, there are important reasons to consider Aboriginal diabetics at special risk. These reasons include the highest reported incidence of vision-threatening retinopathy in Australia, one of the highest ever reported incidences of CSME in the world and the likelihood that the severity of the problem may be underestimated because of the relatively short observation time and the low average time since diagnosis. It is also acknowledged that the small numbers in the study limit our ability to reliably detect progression between subsets of the population and much larger studies are required to make statistically significant comparisons.

Prevalence of diabetic retinopathy in an Aboriginal Australian population: results from the Katherine Region Diabetic Retinopathy Study (KRDRS). Report no. 1.

BACKGROUND: The Katherine Region Diabetic Retinopathy Study (KRDRS) was carried out in the Lower Top End of the Northern Territory of Australia between 1993 and 1996 as part of the Northern Territory Eye Health Program. It investigated diabetic eye conditions and its determinants in the Aboriginal Australian population of the region. METHODS: The study provided cross-sectional data about diabetic retinopathy in the Aboriginal diabetic population of the Katherine region in 1993 and in 1996. A total of 234 people with diabetes were examined in 1993 and 243 in 1996. RESULTS: The prevalence of retinopathy was 18% in 1993 and 21% in 1996. The respective findings for maculopathy were 13% and 10%, for clinically significant macula oedema 8% and 6%, for proliferative stage subject retinopathy 0.9 and 1.3% and for vision-threatening retinopathy 8.5% and 6.7%. In 1993 the prevalence of diabetic retinopathy was 18% in the four major centres compared with 16% in the smaller communities. The findings for 1996 were 25% and 13%, respectively. In 1993 the prevalence of vision-threatening retinopathy was 8% in major centres compared with 7% in other communities. The findings for 1996 were 7% and 8%, respectively. Sex was not significantly related to the prevalence of retinopathy. CONCLUSION: Diabetic retinopathy is as much a problem in Aboriginal communities as in the wider Australian population but presents a unique set of challenges for health services and for clinicians.