Proliferative diabetic retinopathy (PDR) is a leading cause of irreversible vision loss in the United States, with panretinal photocoagulation (PRP) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections both acting as acceptable treatments to reduce the risk of vision loss in these patients. Examining how treatment patterns for PDR have changed over time, researchers recently found that anti-VEGF surpassed PRP as the more common method of treating newly diagnosed PDR from 2013 to 2017, with bevacizumab administered in more than two-thirds of intravitreal injections.

This retrospective cohort analysis used the American Academy of Ophthalmology IRIS Registry database to evaluate 141,317 patients with newly diagnosed PDR. From 2013 to 2017, the average age of PDR diagnosis was 59.2 with 53.3% of patients being male.

Of the newly diagnosed PDR patients, 43.9% received anti-VEGF, 27.1% PRP, 19.6% anti-VEGF+PRP and 9.4% observation. Newly diagnosed PDR patients receiving anti-VEGF were older (60.3) than patients receiving anti-VEGF+PRP (57.4) and PRP (58.4). Men were more likely to receive anti-VEGF+PRP (22.5% vs. 20.6%) and less likely to receive PRP only (29.1% vs. 30.8%).

In 2013, more PDR patients undergoing treatment received PRP only (47.5%) than anti-VEGF only (37.3%) or anti-VEGF+PRP (15.1%). From 2013 to 2017, the percentage of patients treated with PRP only decreased by 5.6% per year and the percentage of patients treated with anti-VEGF only increased by 3.9% per year. By 2017, the majority of patients received anti-VEGF only (52.9%).

PDR patients with diabetic macular edema (DME) were more likely than patients without DME to receive anti-VEGF only (64.3% vs. 31.5%), but the proportion of patients receiving anti-VEGF only increased in both groups from 2013 to 2017 (25.0% to 65.7% for DME patients, 21.1% to 32.9% for non-DME patients).

Among anti-VEGF and anti-VEGF+PRP patients, bevacizumab (69.8%) was the most common intravitreal medication given followed by aflibercept (18.4%) then ranibizumab (11.7%).

“Future studies are needed to determine whether clinical outcomes are impacted by this change in PDR treatment patterns,” the study authors concluded.

Gong D, Hall NE, Elze T, et al. Temporal trends in the treatment of proliferative diabetic retinopathy: an AAO IRIS Registry analysis. Invest Ophthalmol Vis Sci. 2020;61:1382.