Frequent Anti-VEGF Injections Improve Visual Outcomes in Diabetic Macular Edema

Treatment for macular degeneration. Syringe being used to inject Lucentis (ranibizumab) into the eye of a patient being treated for age-related macular degeneration (AMD). Retractors are being used to hold back the eyelids, the eye has been cleaned with iodine eyedrops, and the eye has been numbed with local anesthetic. Lucentis is a monoclonal antibody that treats the vascular damage to the retina seen in AMD. Lucentis prevents abnormal retinal blood vessels forming, and dries up leaking blood vessels.
A real-world study shows better visual acuity gains for patients with diabetic eye disease who undergo at least 5 treatments a year.

Visual acuity (VA) in patients with diabetic macular edema (DME) showed the greatest improvement in eyes that received 5 or more injections of anti-vascular endothelial growth factor (anti-VEGF) as first-line therapy each year, according to research presented at the American Society of Retina Specialists 40th Annual Meeting, held in New York, July 13-16, 2022.

The investigators conducted a retrospective analysis to evaluate the association between long-term visual acuity outcomes and use of anti-VEGF intravitreal therapy (IVT) in patients with DME in routine clinical practice in the United States.

The researchers used de-identified electronic medical records from the IRIS® (Intelligent Research in Sight) Registry of patients with treatment-naïve DME (defined as no prior IVT in the past 12 months) who were initiating anti-VEGF IVT between January 1, 2015 and December 31, 2019. They reported the change in VA from baseline and anti-VEGF IVT frequency, as the average number of injections and intervals, with up to 6 years of follow up, and stratified VA outcomes by baseline VA and number of injections for each year.

A total of 190,345 eyes of 147,687 patients were included in the study (median age 64.2±11.4 years, 64.5% White, 14.9% Black, 2.9% Asian, 16.4% Hispanic). The median follow-up duration was 2.1 years.

At year 1, the team found that 124,684 eyes received a mean of 3.9±2.8 anti-VEGF injections, with an average injection interval of 10.0±7.9 weeks; these patients gained a mean of 3.2±16.4 letters from baseline. 

Among patients with 6 years of follow up, they found that 1235 eyes received a mean of 2.9±2.1 injections, with an average interval of 12.3±8.2 weeks between injections in year 6; these patients gained a mean of 0.5±19.7 letters from baseline. 

When the researchers stratified by year, they found that patients who received 1 to 2 injections had a change of +2.8 from baseline compared with +4.8 in those who received 11 or more injections in year 1. They reported that this trend was consistent in the following years. Across years 3 to 6, patients who received 1 to 2 injections experienced VA loss from baseline ranging from -0.28 to -1.12, and at year 6, patients who received 3 to 4 injections experienced VA loss from baseline of -0.53. The team found that patients who received 5 or more injections did not experience VA loss from baseline.

Limitations of the study included the retrospective design, potential unmeasured confounding factors, estimated BVA as corrected Snellen VA converted to Early Treatment Diabetic Retinopathy Study letters, and use of a model unadjusted for time from initial diagnosis to anti-VEGF treatment initiation.  

Disclosure: This research was supported by F. Hoffmann-La Roche Ltd. Please see the original reference for a full list of disclosures.


Kuo B, Tabano D, Garmo V, et al. Association of real-world visual acuity outcomes and frequency of anti-VEGF injections in patients with diabetic macular edema: 6-year follow-up using the IRIS registry. Poster presented at: The 40th annual meeting of the American Society of Retina Specialists; June 13-16, 2022; New York. Poster 213.