Fluctuations in Central Subfield Thickness Associated With Worse Visual Outcomes in Patients With Diabetic Macular Edema in Clinical Trial Setting

Starr, Matthew R.; Salabati, Mirataollah; Mahmoudzadeh, Raziyeh; Patel, Luv; Ammar, Michael; Hsu, Jason; Ho, Allen C.; Kuriyan, Ajay E.

doi:10.1016/j.ajo.2021.06.030

Cited by 29 publications

(34 citation statements)

References 28 publications

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“…9 More recently, using the same clinical trials included in this study (Diabetic Retinopathy Clinical Research [DRCR] protocols T and V), our previous study established that fluctuations in retinal thickness have been associated with worse visual acuity outcomes in patients with diabetic macular edema as well. 10 While CST fluctuations may serve as a more reliable marker of treatment response and visual outcomes in patients with DME than individual CST readings as described in our previous study, it is still unclear as to what baseline characteristics may predict which patients may be prone to CST fluctuations over time. 10…”

Section: Introductionmentioning

confidence: 72%

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Factors Associated with Fluctuations in Central Subfield Thickness in Patients with Diabetic Macular Edema Using Diabetic Retinopathy Clinical Research Protocols T and V

Torjani¹,

Mahmoudzadeh²,

Salabati³

et al. 2023

Ophthalmology Science

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Section: Introductionmentioning

confidence: 72%

“…10 While CST fluctuations may serve as a more reliable marker of treatment response and visual outcomes in patients with DME than individual CST readings as described in our previous study, it is still unclear as to what baseline characteristics may predict which patients may be prone to CST fluctuations over time. 10…”

Section: Introductionmentioning

confidence: 72%

Factors Associated with Fluctuations in Central Subfield Thickness in Patients with Diabetic Macular Edema Using Diabetic Retinopathy Clinical Research Protocols T and V

Torjani¹,

Mahmoudzadeh²,

Salabati³

et al. 2023

Ophthalmology Science

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“…[37][38][39] It should be noted that the ultimate goal of the treatment of DME is to keep the macula dry, avoiding fluctuations in macular thickness, which are known to be associated with poorer visual outcomes in eyes with DME. 40,41 Therefore the presence of a long-lasting therapy in the eye will be of interest for such aim.…”

Section: Specific Considerationsmentioning

confidence: 99%

“…The ultimate goal of the treatment is to keep the macula dry, avoiding fluctuations in macular thickness which are known to be associated with poorer visual outcomes in eyes with DME. 40,41 Patient monitoring. Due to its pharmacokinetics, FAc implant should not be considered as an "attack" treatment but rather as a background therapy that helps stabilize the disease when injected preferably in a patient where the DME responds to steroid therapy.…”

Section: Specific Considerationsmentioning

confidence: 99%

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Fluocinolone acetonide implant in diabetic macular edema: International experts’ panel consensus guidelines and treatment algorithm

Kodjikian

Bandello

Smet

et al. 2022

European Journal of Ophthalmology

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Center-involving diabetic macular edema (DME) is a leading cause of vision impairment in working-age adults. While its management is particularly challenging in a poorly compliant population, continuous innovation and the advent of new molecules have improved its outcome. The control of glycemia and of systemic aggravating factors remain essential to slow down progression of disease complications including DME. The indications for macular laser photocoagulation has progressively been phased out as a standard of care and replaced by local intraocular anti-VEGFs biologics and glucocorticoids (GCs). Intravitreal GCs in controlled-release drug delivery systems have allowed to reduce injection frequency and treatment burden. The non biodegradable Fluocinolone Acetonide (FAc) implant allows a long-lasting stabilization of both functional and anatomic improvements. However, adequate patient selection and monitoring through regular follow-up are essential for optimal results. Based on their experience and the latest literature, the aim of the present review is to provide international expert panel consensus on the place of the FAc implant in the treatment algorithm of DME, as well as its safety profile and how to manage it.

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Anti-VEGF therapy for the long-term management of diabetic macular edema: a treat-to-target strategy based on macular morphology

Nakao,

Kusuhara,

Murakami

2024

Graefes Arch Clin Exp Ophthalmol

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In an aging population, the prevalence and burden of diabetes mellitus, diabetic retinopathy, and vision-threatening diabetic macular edema (DME) are only expected to rise around the world. Similarly to other complications of diabetes mellitus, DME requires long-term management. This article aims to review the current challenges associated with the long-term management of DME, opportunities to improve outcomes for patients, and to develop a treat-to-target strategy based on macular morphology. At present, intravitreal anti–vascular endothelial growth factor (VEGF) therapy is the standard of care for the management of DME; however, best-achievable vision outcomes with treatment are reliant on frequent injections and close monitoring, which are difficult to maintain in current clinical practice because of the burden this imposes on patients. Achieving and maintaining good vision with treatment are the most important factors for patients with DME. Landmark trials have shown that vision gains with anti-VEGF therapy are typically accompanied by anatomical improvements (e.g., reductions in retinal thickness); therefore, multimodal imaging measures of macular morphology are often used in patients with DME to guide real-world treatment decisions. We would like to propose a hypothetical treat-to-target algorithm to guide physicians on treatment strategies for the long-term management of DME. Alternative measures of retinal fluid (e.g., persistence, stability, location) may be stronger predictors of visual acuity in DME, although further research is required to confirm whether alternate quantifiable biomarkers such as subretinal fluid and intraretinal fluid volumes can be used as a biomarker of clinical improvement. Identifying novel biomarkers and treatments that target neuroinflammation and neurodegeneration, improving patient-physician communication around treatment adherence, and using treat-to-target measures may help to ensure that the long-term benefits of treatment are realized.

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Fluctuations in Central Subfield Thickness Associated With Worse Visual Outcomes in Patients With Diabetic Macular Edema in Clinical Trial Setting

Cited by 29 publications

References 28 publications

Factors Associated with Fluctuations in Central Subfield Thickness in Patients with Diabetic Macular Edema Using Diabetic Retinopathy Clinical Research Protocols T and V

Factors Associated with Fluctuations in Central Subfield Thickness in Patients with Diabetic Macular Edema Using Diabetic Retinopathy Clinical Research Protocols T and V

Fluocinolone acetonide implant in diabetic macular edema: International experts’ panel consensus guidelines and treatment algorithm

Anti-VEGF therapy for the long-term management of diabetic macular edema: a treat-to-target strategy based on macular morphology

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