Proactive Diabetic Eye Disease Management Superior to Delayed Treatment

In 100 weeks of follow up, patients demonstrated superior structural and visual outcomes when they were treated with intravitreal aflibercept injection proactively, according to a presentation at the American Academy of Ophthalmology 2021 meeting, held November 12-15 in New Orleans. 

The findings presented were culled from the VISTA (ClinicalTrials.gov Identifier: NCT01363440) and VIVID (ClinicalTrials.gov Identifier: NCT01331681) trials, which studied patients with diabetic macular edema (DME), and the PANORAMA trial (ClinicalTrials.gov Identifier: NCT02718326), which evaluated patients with diabetic retinopathy. 

A single researcher reviewed the patient records, particularly their best corrected visual acuities (BCVA) (in ETDRS letters) and central subfield thicknesses at baseline and following treatment with intravitreal injections of an anti-vascular endothelial growth factor (VEGF) drug. 

In the VISTA and VIVID trials, patients received injections of aflibercept 2q4 (n=290), 2q8 after 5 monthly doses (n=286), or laser (with aflibercept rescue [2q8] for vision loss initiated from week 24; n=109) to Week 100. In the PANORAMA trial, patients received aflibercept injections 2q16 (n=135) or 2q8/p.r.n. (n=134) after loading phase, or sham (n=133). Eyes could be rescued in cases of proliferative diabetic retinopathy or anterior segment neovascularization, or for center-involved DME.

The investigator found that the participants in the VISTA/VIVID trials treated 2q4 had mean BCVAs of 59.8 letters at baseline and 71.5 letters at week 100. Those treated 2q8 had a baseline BCVA of 59.1 letters, and 70.2 letters at week 100. Mean BCVA for the patients who underwent the laser/rescue approach had a 59.5 letter BCVA at baseline, 49.0 letters at rescue initiation (RI), and 57.9 letters at Week 100. Their mean central subfield thicknesses at baseline were 493.1 µm in the 2q4 group, 497.6 µm in the 2q8 group. These dropped to 289.4 µm and 290.1 µm, respectively, by week 100. The mean CST in the laser/rescue group was 537.5 µm at baseline, which was 538.5 µm at rescue initiation and 272.9 µm at week 100.

In the PANORAMA trial, the investigator reported that a higher proportion of sham-treated patients who received rescue still had diabetic retinopathy severity scale scores of 61 or higher, and CST that were 300 µm or thicker at week 100, compared with IAI groups.

Reference

Do DV. Impact of delayed or proactive treatment in diabetic retinal disease: experience from VISTA/VIVID and PANORAMA. Poster presented at: The American Academy of Ophthalmology; November 12-15; New Orleans. Abstract PO334.