The American Academy of Ophthalmology recommends patients with proliferative diabetic retinopathy (PDR) should be considered for panretinal photocoagulation (PRP) treatment within one month of diagnosis. New research in the American Journal of Ophthalmology lends more credence to this suggested timeline, as a team found patients who delayed PRP beyond 31 days had worse visual outcomes compared to individuals treated earlier. Additionally, the researchers from Case Western Reserve University School of Medicine and the Cole Eye Institute at the Cleveland Clinic reported hospital admissions significantly delayed PRP delivery.
The study included 259 patients diagnosed with PDR who were treated with PRP from 2015 to 2020. The investigators compared visual acuity (VA) outcomes up to 24 months between patients treated the day of diagnosis, one to 14 days after, 14 to 31 days after and more than 31 days post-diagnosis. The study also considered medical comorbidities (coronary artery disease/myocardial infarction, heart failure, chronic kidney disease, dialysis, stroke, inpatient admission), laboratory values (hemoglobin A1c, blood urea nitrogen, serum creatinine) and socioeconomic factors (health insurance, median household income of zip code and distance from zip code to treatment site).
Mean time to treatment for all patients was approximately 28 days.
The study found VA was significantly decreased in patients who received PRP after 31 days compared with those treated on the day of diagnosis at 12 and 24 months. Also of note: Inpatient admission between diagnosis and treatment was significantly associated with an increase in time to treatment (86.5±50.2 days).
Ohlhausen M, Payne C, Greenlee T, et al. Impact and characterization of delayed panretinal photocoagulation in proliferative diabetic retinopathy. Am J Ophthalmology. October 20, 2020. [Epub ahead of print].