<p>Five-Year Patterns of Diabetic Retinopathy Progression in US Clinical Practice</p>

Abstract

Purpose To characterize the natural course of diabetic retinopathy (DR) in contemporary clinical practice. Patients and Methods This was a retrospective analysis of US claims data collected between January 1, 2006, and April 30, 2017. Patients aged ≥18 years with continuous medical and prescription insurance coverage for 18 months before DR diagnosis (index date) and for a follow-up period of 5 years were included (N=14,490). The time and risk of progressing to severe nonproliferative DR (NPDR) or proliferative DR (PDR) and of developing diabetic macular edema (DME) were evaluated over 5 years in patients stratified by DR severity at initial diagnosis. Results The estimated probability of progressing to severe NPDR or PDR within 5 years of diagnosis was 17.6% for patients with moderate NPDR versus 5.8% for mild NPDR. The probability of developing DME within 5 years was 62.6%, 44.6%, and 28.4% for patients diagnosed with severe NPDR, moderate NPDR, and PDR, respectively, versus 15.6% for mild NPDR. Among those observed to progress, median time to severe NPDR or PDR was approximately 2.0 years in patients with moderate NPDR, whereas median time to DME was approximately 0.5 years in patients with severe NPDR, 1.3 years in moderate NPDR, and 1.6 years in PDR. Relative to mild NPDR, adjusted hazard ratios (95% confidence interval) for progression to severe NPDR or PDR within 5 years were 3.12 (2.61–3.72) in patients with moderate NPDR, and for incident DME were 5.92 (5.13–6.82), 3.54 (3.22–3.91), and 1.96 (1.80–2.14) in patients with severe NPDR, moderate NPDR, and PDR, respectively. Conclusion The risk of DR progression and DME over 5 years was highest among patients diagnosed with moderate and severe NPDR, respectively. Our findings reinforce the importance of close monitoring for these patients to avoid unobserved disease progression toward PDR and/or DME.

Effect of less aggressive treatment on diabetic retinopathy severity scale scores: analyses of the RIDE and RISE open-label extension

“…Data from a retrospective analysis that used medical claims data for patients with DR who had not received anti-VEGF therapy, laser photocoagulation, intravitreal steroid treatment or retinal surgery during the baseline period support the interpretation of our data for the native mild-to-moderate NPDR subgroup. The authors of this analysis reported that the risk of DR progression and DME over 5 years was highest among patients with an initial diagnosis of moderate and severe NPDR, respectively, and that patients with mild NPDR were the least likely to progress 8. A separate post hoc analysis of data from the OLE after RIDE/RISE showed that patients who required a higher number of PRN ranibizumab injections tended to have a longer duration of DME and greater retinal thickening than those who required fewer injections; they also received more focal macular laser surgery, which was indicative of chronic disease 9…”

Predictive Assessment of Quantitative Ultra-Widefield Angiographic Features for Future Need for Anti-VEGF Therapy in Diabetic Eye Disease

“…In a recent study, increased macular vessel area was extracted from the UWFA frames of moderate and severe NPDR eyes compared to PDR eyes [23]. Another study demonstrated a higher risk of DME development in moderate and severe NPDR compared to PDR [24]. Further studies investigating the integrative impact of DR severity compared or combined with quantitative angiographic features on future treatment should be explored.…”

A Caveat About Financial Incentives for Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy

“…If a prophylactic regimen were adopted across the United States, the pool of diabetic patients who now qualify for injection therapy would increase substantially, further compounding costs. 19 Policy makers who are setting reimbursement levels for various procedures should be aware of the possibility of financial incentives for two treatment strategies that are equally efficacious for patient care, but one of which costs the healthcare system significantly more. 7 Further reductions in vitrectomy reimbursements, which have already been falling over time, may paradoxically increase overall costs to the healthcare system by driving more practices toward an aflibercept-based strategy for treating diabetic vitreous hemorrhage.…”