A recent study reviewing five-year outcomes for diabetic macular edema (DME) patients in the DRCR.net Protocol T study who underwent anti-VEGF therapy found a drop-off in visual acuity after the second year. Among those who completed a five-year visit, mean visual acuity (VA) improved from baseline to five years, but dropped between two and five years.  

The participants were randomly assigned to aflibercept, bevacizumab or ranibizumab with protocol-defined follow-up and retreatment for two years. Then, they were managed at clinician discretion and recalled for a five-year visit. Of the 317 eligible participants who followed up at five years, 68% received at least one anti-VEGF treatment between years two and five.

At five years, mean VA improved from baseline by 7.4 letters but decreased by 4.7 letters between years two and five. When baseline VA was 20/50 to 20/320, the mean five-year VA was 11.9 letters better than baseline but 4.8 letters worse than it was at two years. When baseline VA was 20/32 to 20/40, the mean five-year VA was only 3.2 letters better than baseline but 4.6 letters worse than when observed at two years. Mean central subfield thickness decreased by 154μm from baseline to five years and was stable between the second and fifth year.

The researchers are led to believe that looking into strategies that will improve long-term outcomes in eyes with DME seems warranted to determine if different management approaches can better maintain VA.

Glassman AR, Wells III JA, Josic K, et al. Five-year outcomes after initial aflibercept, bevacizumab or ranibizumab treatment for diabetic macular edema (Protocol T Extension Study). Ophthalmology. March 29, 2020. [Epub ahead of print].