Researchers recently described and compared the functional and anatomical 12-month outcomes of untreated and treated diabetic macular edema (DME) in eyes with excellent baseline visual acuity (VA) in a real-world setting. They presented their findings last week at the annual ARVO conference in Vancouver. The team discovered that these patients maintained vision after a year, regardless of whether their DME was treated.

This retrospective, multicenter, observational cohort study included eyes that had DME with baseline VA ≤0.1 logMAR (≥20/25 Snellen) and central subfield thickness (CST) >250µm with intra- and/or sub-retinal fluid. The team reviewed patient charts for demographic data, baseline characteristics, prior DME treatment, VA and CST at baseline and months three, six, nine and 12 and DME treatment during the 12-month follow-up. The main outcome measures were changes in VA and CST at 12 months in treated vs. observed eyes.

A total of 249 eyes of 211 patients were included, of which 155 eyes were treated during follow-up and 94 were observed. The researchers found that the majority of eyes maintained vision (VA loss <5 letters or VA gain) at 12 months (58.1% of those treated and 73.4% of observed eyes). In the vast majority of observed eyes with stable VA within the first six months (63/73 eyes, 86.3%), they note that VA was maintained throughout the follow-up (-0.1±3.8 letters). In 36.7% of eyes that were initially observed, they saw a VA loss ≥5 letters within six months. Within those eyes, they add that observation (n=21) led to worse visual outcomes than treatment (n=33) (-4.2 letters vs. -7.8 letters). In eyes in which treatment was initiated at baseline (n=102), the team found intensive treatment (eight to 12 anti-VEGF injections during the 12 months of follow-up) led to CST improvement (-85.9µm vs. +11.3µm) but there was no significant difference in visual acuity (-0.3 letters vs. -1.8 letters) compared with observation.

“This study supports close observation of eyes with DME and very good VA with consideration of treatment when a one-line drop in vision is observed,” the study authors concluded in their ARVO abstract.

Busch C, Iglicki M, Fraser-Bell S, et al. Observation versus treatment in diabetic macular edema with very good visual acuity—the OBTAIN study. ARVO 2019. Abstract 2600-B0131.