While clinical trials offer insight into disease activity, they aren’t necessarily reflective of the whole picture. To fill in the missing pieces, researchers conducted a retrospective analysis of US claims data from 14,490 adults to characterize the natural course of diabetic retinopathy (DR). They concluded that patients diagnosed with moderate to severe non-proliferative DR (NPDR) are at the greatest risk for DR progression and diabetic macular edema (DME).

The team found that the risk of progression to severe NPDR or proliferative DR (PDR) within five years was approximately three-fold greater in patients diagnosed with moderate compared with mild NPDR (17.6% vs. 5.8%). They noted that among the patients with moderate NPDR who experienced progression, the median time to severe NPDR or PDR was two years.

The estimated probability for developing DME within five years was 62.6% for those with severe NPDR, 44.6% for those with moderate NPDR and 28.4% for those with mild NPDR. Progression to DME was half a year for those with severe NPDR, 1.3 years for those with moderate NPDR and 1.6 years for those with mild PDR.

“Data analyzed in this study were collected from a larger commercial payor database; therefore, we expect our results to be more representative of current clinical practice than those observed under trial conditions,” the researchers explained in their paper. “Our findings reinforce the importance of close monitoring of these patients, as advocated in current clinical guidance, to avoid unobserved progression toward vision-threatening levels of DR.”

Probability of Developing DME Within Five Years of DR

 NPDR Class Risk of Progression Time to Presentation
Severe 62.6% 0.5 years
Moderate 44.6% 1.3 years
 Mild 28.4% 1.6 years

Moshfeghi A, Garmo V, Sheinson D, et al. Five-year patterns of diabetic retinopathy progression in US clinical practice. Clin Ophthalmol. 2020;14:3651-9.