Even though most eyes with diabetic macular edema (DME) and good baseline visual acuity (VA) are manageable with observation, a significant proportion will require treatment for vision loss. In an effort to identify these at-risk patients, researchers found that DME patients with good baseline VA are at increased risk for VA loss if their inner retina layers are disorganized, hyper-reflective foci are present and the ellipsoid zone is disrupted at baseline.

This sub-analysis looked at the results of a 12-month, retrospective study to find the correlation between baseline characteristics and VA loss of at least 10 letters during follow up. Of the initial 249 eyes, 147 were observed and 80 received anti-VEGF treatment at baseline.

The team observed VA loss of upwards of 10 letters in 21.8% and 24.3% of the observed and treated cohorts, respectively. Within observed eyes, they noted that the presence of hyper-reflective foci and inner retina layer disorganization were associated with a higher risk of VA loss. Tacking on ellipsoid zone disruption to the list further upped the risk of VA loss, they added. In eyes with all three factors at baseline—15 observed and 19 treated eyes—the risk of VA loss was 46.7% in the observed cohort and 26.3% in the treated cohort.

“Earlier treatment with anti-VEGF in these patients may potentially decrease the risk of VA loss at 12 months,” the study authors concluded in their paper.

Busch C, Okada M, Zur D, et al. Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuity. Acta Ophthalmologica. March 1, 2020. [Epub ahead of print].