Treatment of diabetic macular edema in real‐world clinical practice: The effect of aging

Abstract

Aims/Introduction: In older patients, the management of diabetic macular edema (DME) can be complicated by comorbidities, geriatric syndrome, and socioeconomic status. This study aims to evaluate the effects of aging on the management of DME. Materials and Methods: This is a real-world clinical study including 1,552 patients with treatment-na€ ıve center-involved DME. The patients were categorized into 4 categories by age at baseline (C1, <55; C2, 55-64; C3, 65-74; and C4, ≥75 years). The outcomes were the change in logarithm of the minimum angle of resolution bestcorrected visual acuity (logMAR BCVA) and central retinal thickness (CRT), and the number of treatments from baseline to 2 years. Results: From baseline to 2 years, the mean changes in logMAR BCVA from baseline to 2 years were -0.01 in C1, -0.06 in C2, -0.07 in C3, and 0.01 in C4 (P = 0.016), and the mean changes in CRT were -136.2 lm in C1, -108.8 μm in C2, -100.6 lm in C3, and -89.5 lm in C4 (P = 0.008). Treatments applied in the 2 year period exhibited decreasing trends with increasing age category on the number of intravitreal injections of anti-VEGF agents (P = 0.06), selecting local corticosteroid injection (P = 0.031), vitrectomy (P < 0.001), and laser photocoagulation outside the great vascular arcade (P < 0.001). Conclusions: Compared with younger patients with DME, patients with DME aged ≥75 years showed less frequent treatment, a lower BCVA gain, and a smaller CRT decrease. The management and visual outcome in older patients with DME would be unsatisfactory in real-world clinical practice.

Patterns of anti-vascular endothelial growth factor treatment for chorioretinal vascular diseases: Analysis of a nationwide claims database in Japan

“…A US study also reported no change in the injection frequency in the first year of anti-VEGF treatment for patients with DME over 2013-2018 [12]. Meanwhile, a Japanese study examined the number of anti-VEGF injections in patients with DME 2 years from treatment initiation, starting between 2010 and 2015, and a significant increasing trend was observed [13]. The shorter treatment interval and exclusion of the period before the maintenance phase in our study may contribute to these different results.…”

Deep learning assisted fluid volume calculation for assessing anti-vascular endothelial growth factor effect in diabetic macular edema

“…First, as the high-resolution OCTA used in this study has denser scanning, which offers the possibility of accurate estimation of fluid volume, this deep learning-based algorithm may be limited in its applicability to more widely accessible structural OCT scans, which only equip a less-dense scan pattern. Second, this study did not determine the impact of clinical care and patients age [ 29 ] on therapeutic effects across patients, which could have influenced the findings. Third, in consideration of the limited sample size and relatively short observation period, there might be inherent biases that could potentially influence the generalizability.…”

Recent updates in factors associated with incidence and screening of diabetic eye disease

“…In addition to the age of diabetes onset, aging of the entire population is also related to the phenotype and the pathophysiology of diabetic retinopathy. In particular, diabetic macular edema is becoming increasingly prevalent in the older population of many developed countries; however, its treatment in clinical settings is insufficient 7 , which needs to be addressed in the future.…”