Anti-VEGF is the common treatment to improve visual outcomes for individuals with diabetic macular edema (DME), but little is known about the durability of its effects over time, especially in poorly adherent patients. In a recent study, 90 eyes of 73 patients with DME and treated with anti-VEGF who were lost to follow up (LTFU) for six months or less were evaluated.
Treated patients who were LTFU for a prolonged period experienced a modest decline in VA that recovered after restarting treatment. Although the study shows vision was worse, it recovered within three months after restarting therapy and remained stable until the final follow-up 502 days later.
Inconsistent follow-up may be a cause of poorer outcomes in the treatment of DME, the authors explained. Previous studies found that almost 50% of patients receiving anti-VEGF injections for DME had a therapy break (defined as an absence of greater than 100 days from the recommended follow-up date) and patients with more therapy breaks had significantly greater declines in VA.
“In our study, a modest but significant decline in VA was observed after being LTFU with mean VA declining from about 20/50 at the visit before LTFU to about 20/70 at the first return visit,” the authors noted in their study.
“Despite a prolonged treatment break, patients in our study still recovered vision similar to the visit before LTFU by the final follow-up visit at an average of 1.4 years after resuming therapy. VA was not significantly different from baseline as early as three months after return from LTFU.”
The authors noted this is consistent with results from another previous study which found similar VA at the final visit six months after returning from LTFU compared to baseline levels, though the current study suggests that even longer delays in follow-up may not cause irreversible harm.
“While our study in no way devalues the importance of ongoing follow-up and treatment compliance, it suggests there may be more resilience in vision recovery compared to other retinal diseases such as nAMD or more advanced PDR,” the authors concluded in their study.
Matsunaga DR, Salabati M, Obeid A, et al. Outcomes of eyes with diabetic macular edema that are lost to follow-up after anti-vascular endothelial growth factor therapy. American Journal of Ophthalmology. Epub ahead of print.