Researchers recently found that patients with diabetic macular edema (DME) undergo fewer anti-VEGF injections and exhibit worse visual outcomes in clinical practice than in randomized clinical trials.

This retrospective study evaluated the records of treatment-naïve DME patients from 2013 to 2018. At one year, the team discovered that 28,658 eyes underwent a mean of 6.4 anti-VEGF injections, gaining a mean of +4.2 letters. When classified by anti-VEGF medication and by year, they did not observe clinically significant differences in injection frequency or visual acuity (VA) change.

After one year, the investigators found that half of eyes had received less than seven injections, while less than 20% had received 10 to 13 injections. Beyond two injections, they noted that the mean letters gained had a linear relationship with the mean number of anti-VEGF injections. They added that while eyes with good baseline VA (≥20/40) were at risk of VA loss at one year, those with moderately severe baseline impairment (20/70 to 20/200) who received more than nine injections improved by a mean of +10.3 letters.

“As the healthcare system shifts to value-based approaches, real-world outcomes assume greater importance; these results highlight the necessity for patient counseling on treatment frequency with current anti-VEGF therapy and also highlight the unmet need for longer duration therapies that can address treatment burden,” the study authors concluded in their paper.

Ciulla TA, Pollack JS, Williams DF. Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular oedema: a real-world analysis of 28,658 patient eyes. Br J Ophthalmol. April 7, 2020. [Epub ahead of print].