Are clinical trial patients monitored better than "real-world" patients? That’s the question one bold new study, published in the April edition of the American Journal of Ophthalmology, dares to ask. According to the researchers, patients with diabetic macular edema who are receiving anti-VEGF therapy in a clinical practice undergo less frequent monitoring and fewer intravitreal injections than patients in landmark clinical trials.1 Those patients, naturally, also achieve inferior visual outcomes, the study results show.
The study retrospectively gathered data from the electronic medical records of 110 patients—and 121 eyes—over the course of five years. After 12 months, the data showed the mean number of intravitreal injections in clinical practice was 3.1, mean corrected visual acuity change was +4.7 letters and the proportions of eyes gaining ≥10 or ≥15 letters were 31.4% and 24.0%, respectively.
The American Optometric Association suggests that if DME is present—but is not clinically significant macular edema—clinicians should monitor within two to four months.2
Approximately 3.8% of US diabetes patients (older than 40) have DME, and the risk is higher for black Americans—as well as Hispanic blacks—than for other racial groups.3
1. Holekamp N, Campbell J, Almony A, et al. Vision outcomes following anti-vascular endothelial growth factor treatment of diabetic macular edema in clinical practice. Am J Ophthalmol. April 20, 2018. 20. [Epub ahead of print].
2. American Optometric Association. Eyecare of the patient with diabetic retinopathy: Evidence-based clinical practice guideline. www.aoa.org/Documents/EBO/EyeCareOfThePatientWithDiabetesMellitus%20CPG3.pdf. Accessed May 7, 2018.
3. Varma R, Bressler N, Doan Q, et al. Prevalence of and risk factors for diabetic macular edema in the United States. JAMA Ophthalmol. 2014;132(11):1334-40.