NATURAL HISTORY AND PREDICTORS OF VISION LOSS IN EYES WITH DIABETIC MACULAR EDEMA AND GOOD INITIAL VISUAL ACUITY : RETINA

Secondary Logo

Journal Logo

Advanced Search
Original Study

NATURAL HISTORY AND PREDICTORS OF VISION LOSS IN EYES WITH DIABETIC MACULAR EDEMA AND GOOD INITIAL VISUAL ACUITY

Lent-Schochet, Daniella BS*,†; Lo, Therlinder BA*,‡; Luu, Kieu-Yen BS*; Tran, Steven MD§; Wilson, Machelle D. PhD; Moshiri, Ala MD, PhD*; Park, Susanna S. MD, PhD*; Yiu, Glenn MD, PhD*

Author Information

*Department of Ophthalmology and Vision Science, University of California Davis, Sacramento, California;

†California Northstate University College of Medicine, Grove, California;

‡University of Nevada, Reno School of Medicine, Reno, Nevada;

§Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and

Department of Public Health Sciences/Division of Biostatistics, University of California Davis, Davis, California.

Reprint requests: Glenn Yiu, MD, PhD, UC Davis Eye Center, 4860Y Street, Suite 2400, Sacramento, CA 95817; e-mail: [email protected]

The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860. This project was also supported (in part) by an Alpha Omega Alpha (AOA) C. L. Kuckein Student Research Fellowship. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the AOA Honor Medical Society. G. Yiu is supported by NIH R01 EY032238, NIH R21 EY031108, BrightFocus Foundation, and Macula Society. A. Moshiri is supported by NIH K08 EY027463.

G. Yiu received research support from Clearside Biomedical, Genentech, and Iridex and personal fees for consultancy from Alimera, Allergan, Carl Zeiss Meditec, Clearside Biomedical, Genentech, Gyroscope Therapeutics, Intergalactic Therapeutics, Regeneron, Topcon, and Verily. The remaining authors have no conflicts of interest to disclose.

D. Lent-Schochet and T. Lo contributed equally to this work.

Retina 41(10):p 2132-2139, October 2021. | DOI: 10.1097/IAE.0000000000003167

Purpose: 

To identify clinical and anatomic factor–associated vision loss in eyes with treatment-naïve diabetic macular edema and good initial visual acuity.

Methods: 

Retrospective cohort study after long-term history of eyes with untreated center-involving diabetic macular edema and baseline visual acuity ≥ 20/25 seen at the University of California, Davis Eye Center between March 2007 and March 2018. We collected characteristics including diabetes type, hemoglobin A1c, presence of visual symptoms, visual acuity, and diabetic retinopathy severity; and spectral-domain optical coherence tomography biomarkers including central subfield thickness, intraretinal cyst size, intraretinal hyperreflective foci, disorganization of retinal inner layers, and outer layer disruptions to determine factors associated with vision loss as defined by DRCR Protocol V as threshold for initiating aflibercept therapy.

Results: 

Fifty-six eyes (48 patients) with untreated diabetic macular edema and mean baseline visual acuity of logMAR 0.05 ± 0.05 (Snellen 20/22) were followed for an average of 5.1 ± 3.3 years, with a median time to vision loss of 465 days (15 months). Older age (hazard ratio [HR] 1.04/year, P = 0.0195) and eyes with severe NPDR (HR 3.0, P = 0.0353) or proliferative diabetic retinopathy (HR 7.7, P = 0.0008) had a higher risk of a vision loss event. None of the spectral-domain optical coherence tomography biomarkers were associated with vision loss except central subfield thickness (HR 0.98, P = 0.0470) and cyst diameter (HR 1.0, P = 0.0094).

Conclusion: 

In eyes with diabetic macular edema and good initial vision, those with older age and worse diabetic retinopathy severity should be monitored closely for prompt treatment initiation when vision loss occurs.

Full Text Access for Subscribers:

Not a Subscriber?

Buy
Request Permissions

You can read the full text of this article if you:

Access through Ovid