Abstract
Purpose
To evaluate the management and long-term outcomes of patients with diabetic macular oedema (DMO) and good initial visual acuity in real-world settings.
Methods
We reviewed 122 eyes of 100 patients with treatment-naive DMO and initial best-corrected visual acuity (BCVA) of 20/25 or better. We assessed clinical characteristics, logMAR BCVA, central subfield thickness (CST), cumulative intravitreal injections and laser treatments at yearly intervals, and characteristics at time of initial treatment. Linear mixed effects models were used to identify predictors of visual outcomes.
Results
At presentation, mean BCVA was 0.057 ± 0.048 logMAR (Snellen 20/23) and mean CST was 288 ± 57 μm. After a median follow-up of 3 years, 51% of eyes underwent treatment. More eyes underwent intravitreal injection as initial treatment (54%), but lasers were initiated at an earlier time and at better BCVA. Final BCVA was associated with better BCVA (P < 0.001) and earlier timing (P = 0.017) at initial treatment, but not CST at first treatment (P = 0.634) or cumulative number of injections or lasers (P = 0.441–0.606).
Conclusion
DMO with good initial visual acuity should be monitored closely, as delay in treatment initiation is associated with worse visual outcomes. BCVA at time of initial treatment is the strongest determinant of final visual acuity.
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Funding
BPD is supported by NIH UL1 TR001860. AM is supported by NIH K08 EY027463, NIH U24 EY029904. LSM received personal fees for consultancy from Genentech & Iridex. SSP is supported by NIH 1UG1EY026876 and received grant from received grant support from Allergan and Roche Novartis. GY is supported by NIH K08 EY026101, E. Matilda Ziegler Foundation for the Blind, Barr Foundation for Retinal Research, and Macula Society, received grant support from Alcon, Clearside Biomedical, and Iridex, and personal fees for consultancy from Alimera, Allergan, Carl Zeiss Meditec, Genentech, and Iridex. No funding organisations had any role in the design or conduct of this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
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Luu, KY., Akhter, M.M., Durbin-Johnson, B.P. et al. Real-world management and long-term outcomes of diabetic macular oedema with good visual acuity. Eye 34, 1108–1115 (2020). https://doi.org/10.1038/s41433-019-0647-0
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DOI: https://doi.org/10.1038/s41433-019-0647-0
