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Fong, Donald, S., MD*; Luong, Tiffany, Q., MPH; Contreras, Richard, MS; Jimenez, Jennifer, J., MA; Custis, Peter, H., MD; Patel, Vaishali, PharmD, MS§; Campbell, Joanna, H., PhD§

doi: 10.1097/IAE.0000000000001790
Original Study: PDF Only

Purpose: To assess health care utilization and vision outcomes over 2 years in patients receiving bevacizumab treatment in clinical practice for diabetic macular edema.

Methods: Patients with newly diagnosed diabetic macular edema who received an intravitreal bevacizumab injection within 12 months of initial diagnosis were identified from Kaiser Permanente's 350,000 patients with diabetes mellitus treated between 2008 and 2013. Snellen best-corrected visual acuity (BCVA), number of intravitreal injections, and patient characteristics were abstracted from the electronic record. The main outcome measure was change in BCVA.

Results: Three hundred and nine patients met the inclusion criteria and had 2 years of follow-up after their first bevacizumab injection. These patients had a mean of 3.1 injections (range, 1–17) during the 2-year follow-up. Mean BCVA improvement was 5.4 letters at 12 months and 5.3 letters at 24 months. Only 29.8% of patients demonstrated ≥3 lines of vision improvement from baseline, whereas 12.3% had ≥3 lines of vision loss from baseline at 24 months.

Conclusion: This is the largest U.S. clinical practice–based study of bevacizumab use in diabetic macular edema. Consistent with national studies, the frequency of injection was low. Average BCVA improvement was lower than in anti–vascular endothelial growth factor trials. Significant BCVA improvement was achieved in approximately 30% of patients with newly diagnosed diabetic macular edema.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

*Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California;

Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California;

Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, California; and

§Allergan plc, Irvine, California.

Reprint requests: Donald S. Fong, MD, Department of Ophthalmology, Kaiser Permanente Medical Center, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706; e-mail:

This study was sponsored by Allergan, plc, Dublin, Ireland.

Presented in part at the 38th Macula Society Annual Meeting, Scottsdale, Arizona, February 25–28, 2015.

D. S. Fong and P. H. Custis are partners with Southern California Permanente Medical Group. T. Q. Luong, R. Contreras, and J. J. Jimenez are employees of Southern California Permanente Medical Group. V. Patel and J. J. Campbell are employees of Allergan plc. Medical writing and editorial assistance were provided to the authors by Kakuri Omari, PhD, of Evidence Scientific Solutions, Philadelphia, PA, USA, and funded by Allergan plc, Dublin, Ireland. All authors met the ICMJE authorship criteria. Neither honoraria nor payments were made for authorship. None of the authors has any financial/conflicting interests to disclose.

All work (chart abstraction and analyses) was performed at Kaiser Permanente Southern California.

© 2018 by Ophthalmic Communications Society, Inc.